Thoracocentesis or pleural tap, is an invasive procedure to remove fluid or air from the pleural space for diagnostic or therapeutic purposes.
Drainage of the pleural space can be performed at the bedside.
Indications for this procedure include
- diagnostic evaluation of pleural fluid,
- removal of pleural fluid for symptomatic relief, and
- instillation of sclerosing agents in patients with recurrent, usually malignant pleural effusions.
Preparation:
- Familiarity with the components of a thoracentesis tray is a prerequisite to performing a thoracentesis successfully.
- Recent posterior-anterior (PA) and lateral chest radiographs with bilateral decubitus views should be obtained to document the free flowing nature of the pleural effusion.
- Loculated pleural effusions should be localized by ultrasound or CT prior to drainage.
- Management should be individualized in patients with a coagulopathy of thrombocytopenia. Thoracentesis is more challenging in patients with mechanical ventilation and should be performed with ultrasound guidance if possible.
