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Pleural aspiration animated demonstration

Equipment

Prepare all the equipment on a sterile trolley with the help of an assistant.

• Ultrasound machine and an operator with appropriate experience in pleural ultrasound

• Sterile ultrasound probe cover

• Sterile gloves and gown

• Nitrile gloves

• Sterile field and dressing

• Sterile drapes

• Chlorhexidine cleaning solution

• Lidocaine - check local drug formulary or protocols for doses

• A selection of syringes and needles (21–25 gauge)

• Sample collection bottles

• Blood culture bottles

• Chest drain kit, if required.

Contraindications

• Coagulopathy (avoid in anticoagulated patients until INR <1.5 and platelets > 50x10⁹/l)

• Lack of ultrasound equipment

• Local infection

• Very small fluid volume.

Indications

Pleural aspiration may be for diagnostic purposes (usually removing 20–50 ml fluid) or therapeutic, to relieve symptoms. In this video, we demonstrate diagnostic and therapeutic aspiration.

Indications include:

• Pneumothorax

  • Spontaneous primary pneumothorax (any size)

  • Small secondary spontaneous pneumothorax in patients under 50 years

• Malignant pleural effusions

  • Small volume aspiration for diagnosis

  • Larger volume aspiration to relieve symptoms of dyspnoea

• Pleural effusion associated with sepsis (suspected empyema)

  • Diagnostic for decision to drain

• Pleural effusion of unknown cause.

Complications

The most common complications from pleural aspiration are:

• Pneumothorax

• Procedure failure

• Pain

• Haemorrhage

• Visceral injury

• Empyema.

Aftercare

A chest x-ray after a simple pleural aspiration is not required unless air is withdrawn, the procedure is difficult, multiple attempts are required, or the patient becomes symptomatic.