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Pleural Tap


Medical editor Arne Heilo MD
Radiologist
Oslo University Hospital
Norway

General

Pleural fluid (pleural effusion) is an accumulation of fluid in the pleural space. The fluid compresses the lungs and disrupts its normal function. Symptoms and clinical findings vary and partially depend on the volume of the pleural effusion. Less than about 1/2 L will provide few or no symptoms.

An increase in the amount of pleural fluid can occur acutely or over a long period of time. The pleural fluid may be clear (serous) or bloody, or contain pus if infection is present. In rare cases, the fluid may be rich in fat (chylothorax). The most common causes of pleural effusion are heart failure, pneumonia, malignancy, or lung embolism.

Pleural fluid develops in almost half of all malignant tumors or metastases in the thorax. Lung cancer, breast cancer, gynecological cancer, mesothelioma, lymphoma, and leukemia often give rise to pleural fluid.

Indications

  • Diagnostic—pleural effusion of unknown cause
  • Therapeutic—pleural effusion sufficient to cause dyspnea

Goal

  • Cytological examination of pleural fluid
  • Reduce dyspnea
  • Instillation of chemotherapy

Equipment

  • Pleural tapping set
  • Washing set
  • 5 ml syringe for local anesthesia 
  • Subcutaneous or intramuscular cannula
  • Sterile gloves
  • Secalon catheter or pigtail catheter 

 


Preparation

  • Ultrasound
  • Blood tests according to local scheme.
  • Inform the patient.
  • Hydrocodone tablet to reduce coughing during the tapping can be given as premedication according to the doctor's prescription. 

Implementation

  • The procedure is carried out aseptically and takes approximately 30 minutes.
  • The patient lies in the supine position with the upper body raised, either in bed or on an examination table. The sitting position is also an alternative.
  • The skin is cleaned with chlorhexidine 5 mg/ml.
  • The puncture is made where there is optimal access to the fluid.
  • Xylocain 1% is used for local anesthesia without adrenaline.
  • Local anesthesia is injected in all tissue layers of the thoracic wall, especially the parietal pleura.
  • The position of the needle is shown by ultrasound.
  • A small incision is made in the skin and a Secalon or pigtail catheter is inserted into the pleural space. A three-way tap with bag is connected.
  • The fluid can either be tapped passively or aspirated with a syringe from the tapping set.
  • When the tap is concluded, the catheter is removed unless otherwise specified.
  • The puncture point is bandaged.
  • The pleural fluid is sent in a sterile container for bacterial examination and possibly biochemical or immunological examination.

Complications which can occur:

  • Pneumothorax
  • Bleeding
  • Sowing of malignant cells or microbes in the puncture canal (delayed complication)

Follow-up

  • No follow-up for uncomplicated procedures.
  • For complications, follow-up is individualized depending on severity of complication. 
  • The result will be available after 2-3 days.

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