How should patients be positioned during a diagnostic thoracentesis procedure 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

When possible, patients should sit upright for thoracentesis. Patients should not lean forward, because this causes pleural fluid to move to the anterior costophrenic space and increases the risk of puncture of the liver or spleen. For debilitated and ventilated patients who cannot sit upright, obtain pleural fluid by puncturing over the eighth rib at the midaxillar to posterior axillary line. To avoid puncturing liver or spleen, the needle should not be inserted below the ninth rib. In such patients, imaging may be required to guide thoracentesis.


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