Overview

Pleural Tap (Thoracentesis) is a procedure used to remove fluid from the pleural space for diagnostic or therapeutic purposes. It is essential for managing pleural effusions.

Pleural tap is crucial for diagnosing the cause of pleural effusion, relieving symptoms, and guiding treatment decisions. It provides both diagnostic and therapeutic benefits.

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Indications

✓
Pleural Effusion

Diagnostic evaluation

✓
Malignant Effusion

Therapeutic drainage

✓
Empyema

Infected pleural fluid

✓
Hemothorax

Blood in pleural space

✓
Symptomatic Relief

Dyspnea improvement

Contraindications

Absolute Contraindications

✗ Patient refusal
✗ Coagulopathy
✗ Small effusion

Relative Contraindications

✗ Mechanical ventilation
✗ Bullous lung disease

📋 Equipment Checklist

Check off items as you gather them:

Pre-procedure Preparation

Preparation includes patient consent, imaging review, sterile technique, and equipment setup.

Step-by-Step Procedure

Step 1: Patient Preparation

Explain procedure, obtain consent, position patient.

⚠️ Common Mistakes to Avoid:

  • Inadequate consent
  • Poor positioning

💡 Pro Tip:

Position patient sitting upright.

Step 2: Imaging Review

Review chest X-ray or ultrasound.

⚠️ Common Mistakes to Avoid:

  • No imaging
  • Wrong site

💡 Pro Tip:

Use ultrasound guidance when available.

Step 3: Site Selection

Choose appropriate puncture site.

⚠️ Common Mistakes to Avoid:

  • Wrong site
  • Small effusion

💡 Pro Tip:

Select site with adequate fluid.

Step 4: Sterile Preparation

Prep and drape sterile field.

⚠️ Common Mistakes to Avoid:

  • Inadequate prep
  • Contamination

💡 Pro Tip:

Use strict sterile technique.

Step 5: Local Anesthesia

Infiltrate local anesthetic.

⚠️ Common Mistakes to Avoid:

  • Inadequate anesthesia
  • Wrong technique

💡 Pro Tip:

Anesthetize skin and pleura.

Step 6: Fluid Aspiration

Aspirate pleural fluid with proper technique.

⚠️ Common Mistakes to Avoid:

  • Wrong angle
  • Multiple attempts

💡 Pro Tip:

Use proper needle angle.

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Post-procedure Care

Post-procedure care involves monitoring for complications, specimen handling, and follow-up imaging.

Complications & Management

Complication Incidence Signs Management Prevention
Pneumothorax 5-15% Chest pain, dyspnea Chest X-ray, observation Proper technique
Bleeding 1-3% Hemothorax Chest tube, transfusion Check coagulation
Infection 1-2% Fever, chest pain Antibiotics Sterile technique
Re-expansion pulmonary edema 1-2% Dyspnea, cough Oxygen, diuretics Limit fluid removal

Clinical Pearls

💡

Use ultrasound guidance when available.

🎯

Choose site with adequate fluid.

⚡

Limit fluid removal to 1.5L initially.

🔍

Send fluid for appropriate analysis.

📊

Monitor for complications.

🎨

Use strict sterile technique.

⚠️

Obtain post-procedure chest X-ray.