Pleural Fluid Tapping

Pleural Fluid Tapping


Indications of Pleural fluid tapping
Diagnostic
Therapeutic
Physical, biochemical, cytological and bacteriological study of pleural fluid
Respiratory distress
Massive collection
Contraindications
Contraindications
1.Coagulation disorder
2.Platelet abnormality
3.Severe cough
pleural-fluid-tapping



Procedure
Step-Wise Procedure
1.The total procedure is explained to the patient to make him /her comfortable and relaxed.
2.The patient sitting and leaning forward position with arms folded before him/her and kept over a cardiac table.
3.The site of aspiration may be
6th Intercostal space in the Midaxillary line
7th Intercostal Space In The Posterior Axillary Line
8th Intercostal Space In The Scapular Line
4.The local part is prepared under strict aseptic condition.
5.The site of aspiration is infiltrated from the skin up to parietal pleura through subcutaneous tissue with 2 % lignocaine solution.
6.The pleural aspiration needle is inserted right angle to the skin, just above the upper border of the lower rib (to avoid injury to vessels and nerves).
7.The needle is then attached to a three-way cannula, and the cannula is in turn connected to a 50 mL syringe.
8.Application of suction in the syringe draws pleural fluid into the syringe which is pushed into a kidney-tray via the outlet of the three-way cannula by adjusting its screw.
9.Fluid should be aspirated slowly and much as possible until it is harmful to the patient. (generally not more than 1 litre on the first occasion)
10.The puncture site is sealed with tincture benzoin when the paracentesis is over.
11.The patient should be monitored for next 24-48 hours for development of any complication.
Complications
Complications
1.Pleural shock (as a result of vagal inhibition)
2.Empyema thoracis
3.Hydropneumothorax
4.Acute pulmonary oedema (if the fluid is aspirated very rapidly)
5.Air embolism
6.Injury to intercostal vessels and nerves
7.Haemothorax
8.Subcutaneous emphysema
9.Cardio-respiratory embarrassment with circulatory collapse

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