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Equipment
Dressing pack
Sterile gloves
Skin preparation – Solu-IVTM Swabstick (Chlorhexidine 2% and Alcohol 70%)
1x10ml and 1x50ml syringe
26G and 22G needles
2 x 5ml amps 1% plain Xylocaine
3 way stop cock
Size 14G and size16G 45mm Instye IV catheter
IV giving set
1 pack sterile gauze squares and/or swabs
1 sterile dressing sheet (included in dressing pack)
MicroporeTM tape and gauze squares for padding and securing catheter
2 x large TegadermTM dressings
Paper bag
Sharps box
Sticky plaster
Additional Equipment that may be required
2 specimen pottles
Contraindications
Absolute contraindications include an uncorrected coagulopathy, cardiac,
haemodynamic or rhythm instability, unstable angina or respiratory distress not
attributed to the pleural effusion
Relative contraindications include lack of patient co-operation, mechanical ventilation,
bullous lung disease and local chest wall infection
Occasionally, due to frailty or poor overall condition, it may be inappropriate to perform
the procedure as an outpatient and the patient must be admitted.
Procedure
Most patients will have had an USS and ‘x marks the spot’ performed and a suitable
site for aspiration will have been marked on the skin. This is especially useful if the
fluid is loculated, and should give you a guide as to the volume and depth of fluid. If no
USS has been performed, obtain a lateral decubitus chest x-ray to confirm the
presence of free fluid - pleurocentesis may be performed safely if 10mms of free fluid is
identified on lateral decubitus chest x-ray.
The position of the effusion should be confirmed by percussion and the side double
checked on the PA CXR.
Explain the procedure to the patient, verbal consent is satisfactory.
Position the patient in a chair, leaning forward with the arms on a pillow on a bed or
with the patient sitting backwards on a chair with their arms on a pillow over the back of
the chair.
Using percussion and vocal resonance locate the upper limit of the effusion and the
area of maximal dullness overlying the known location of the effusion. If an ultrasound
has been used to identify the effusion position the patient in the same way as for the
ultrasound.
Specimen collection
Diagnostic specimens may be sent to the laboratory. It may be useful to send a large
volume of fluid (up to 500mls) particularly attempting to prove malignancy. Canterbury
Health Laboratories should be consulted for the specifics of sample collection in
individual cases.
Documentation
The amount of fluid drained should be recorded in the Oncology Notes as well as in the
Hospital Clinical Records (if performed in the DSU). Note also whether problems or
complications were encountered, including relevant recordings.