Aspiration site should be chosen by an experienced operator using thoracic ultrasound at the time of the procedure and ultrasound should be available for use throughout the procedure if required.
Sterile skin preparation and aseptic technique, using sterile drapes to cover the patient.
Infiltrate skin, intercostal muscle and parietal pleura with 10–20 mL 1% lidocaine (Figures 10.1 and 10.2).
The needle should be aimed above the upper border of the rib, avoiding the neurovascular bundle.
Aspirate pleural fluid with a green (21 G) needle and 50 mL syringe (Figure 10.3).
After the diagnostic tap, note the appearance of the pleural fluid. The sample should be sent for analysis in three sterile pots (Table 10.1).
A routine CXR is not indicated after thoracocentesis in asymptomatic non‐ventilated patients. Ultrasound by an experienced clinician has a diagnostic sensitivity for pneumothorax similar to CXR.
Direct (also known as ‘real‐time’) ultrasound guidance may be required for small or loculated effusions, or to distinguish fluid from pleural thickening.
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