How is the diagnostic thoracentesis performed in the workup for pleural effusion (fluid on the lungs)?

Updated: Dec 28, 2018
  • Author: Kamran Boka, MD, MS; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

After the site is disinfected with chlorhexidine (preferred) or povidone/iodine (no longer recommended) solution and sterile drapes are placed, anesthetize the skin, periosteum, and parietal pleura with 1% lidocaine through a 25-gauge needle. If pleural fluid is not obtained with the shorter 25-gauge needle, continue anesthetizing with a 1.5-inch, 22-gauge needle. For patients with larger amounts of subcutaneous tissue, a 3.5-inch, 22-gauge spinal needle with inner stylet removed can be used to anesthetize the deeper tissues and to aspirate pleural fluid.

Confirm the correct location for thoracentesis by aspirating pleural fluid through the 25- or 22-gauge needle before introducing larger-bore thoracentesis needles or catheters. If pleural fluid is not easily aspirated, stop the procedure and use ultrasonography or chest CT scanning to guide thoracentesis.


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