Clinical Procedure
 
Aliases:
Pleural aspiration
Pleural effusion tap
Pleural effusion aspiration
Pleural tap
Pleural taps

Topic aliases are alternate phrasings for a particular topic.


Pleural fluid aspiration is performed for either diagnostic or therapeutic purposes.

Diagnostic taps usually require the use of small caliber needles or cannulas, whereas therapeutic taps require larger caliber cannulas or catheters for removal of larger volumes.

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Lungs in patients with chronic effusions will not expand as quickly as those in patients with acute effusions.

Take this into account when performing therapeutic taps. Do not remove too much pleural fluid, ensuring you stop as soon as the patient starts complaining of chest discomfort which may suggest high negative pleural pressure.

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Check coagulation status prior to proceeding in patients at risk of coagulopathy:

- Unwell patients
- Liver failure
- Anticoagulant therapy
- Nutritional deficiency

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IV access must be obtained prior to performing the procedure.

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Pulse oximetry will be useful to monitor for both oxygen saturation and heart rate which may help reveal an inadvertant pneumothorax.

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If a mark is being placed under ultrasound by someone else before the procedure, try to watch it being marked so you can see what position the patient was in.

Fluid shifts around significantly with changing positions.

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Where possible, position the patient on the side of the bed sitting up with a pillow on their lap or tray table in front of them to support their arms.

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For diagnostic taps only a small amount of fluid is usually required (25-50 ml ) and a small gauge needle or cannula is usually sufficient.

21g or 23g needle or
20g or 22g cannula

You will know from your seeker needle whether the fluid is serous (small needle is ok) or turbid (larger needle will be required)

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