Pleural Fluid Tapping
Pleural Fluid Tapping
Indications of Pleural fluid tapping
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Diagnostic
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Therapeutic
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Physical, biochemical, cytological and bacteriological study of pleural fluid
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Respiratory distress
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Massive collection
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Contraindications
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Contraindications
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1.Coagulation disorder
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2.Platelet abnormality
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3.Severe cough
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Procedure
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Step-Wise Procedure
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1.The total procedure is explained to the patient to make him /her comfortable and relaxed.
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2.The patient sitting and leaning forward position with arms folded before him/her and kept over a cardiac table.
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3.The site of aspiration may be
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6th Intercostal space in the Midaxillary line
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7th Intercostal Space In The Posterior Axillary Line
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8th Intercostal Space In The Scapular Line
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4.The local part is prepared under strict aseptic condition.
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5.The site of aspiration is infiltrated from the skin up to parietal pleura through subcutaneous tissue with 2 % lignocaine solution.
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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).
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7.The needle is then attached to a three-way cannula, and the cannula is in turn connected to a 50 mL syringe.
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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.
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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)
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10.The puncture site is sealed with tincture benzoin when the paracentesis is over.
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11.The patient should be monitored for next 24-48 hours for development of any complication.
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Complications
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Complications
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1.Pleural shock (as a result of vagal inhibition)
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2.Empyema thoracis
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3.Hydropneumothorax
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4.Acute pulmonary oedema (if the fluid is aspirated very rapidly)
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5.Air embolism
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6.Injury to intercostal vessels and nerves
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7.Haemothorax
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8.Subcutaneous emphysema
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9.Cardio-respiratory embarrassment with circulatory collapse
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