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Pleural fluid may require aspiration as a therapeutic procedure (for relief of dyspnoea) or to help in making a diagnosis (to obtain material for microscopy and culture, biochemical or other analysis). Carrying out this procedure under imaging guidance reduces the likelihood of failure to remove any/sufficient fluid or to inadvertently injure other organs.
As with all invasive procedures:
Appropriate clinical examination and imaging investigations (e.g. chest X-ray, chest ultrasound or chest CT) should be carried out before the procedure. The choice of imaging will depend on the patient’s background clinical condition.
If there is any reason to suspect that platelet count or international normalised ratio (INR) may be abnormal (e.g. drug treatment, comorbidities, sepsis etc.), a full blood examination and coagulation profile should be carried out. It is prudent to check the usual practice of the facility/hospital where the procedure is to be carried out regarding their preferences for preprocedural tests for coagulation. These are likely to vary depending on the pretest probability of a clotting problem and this depends on the patient’s individual situation. It is therefore difficult to be prescriptive about who does and does not need testing before pleural aspiration.
It is usual for anticoagulation and antiplatelet therapy to be ceased before pleural aspiration. If the risks of ceasing these medications are considered too high, such as in patients with recently inserted stents or other cardiac intervention, this should be discussed with the radiologist before requesting the procedure.
The patient should be fasted for 4 hours before the procedure.
There are no absolute contraindications.
An alternative method of draining pleural fluid is via video assisted thoracoscopy. However, this is a more invasive surgical procedure, which is carried out by a thoracic surgeon and requires a general anaesthetic. It is usually reserved for pleural fluid that is loculated or focal pleural collections, such as an empyema.
Page last modified on 26/7/2017.
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