Pleural effusion
Sampling protocol
- Before institution of antibiotic therapy
Contraindications
- Bleeding diathesis / Anticoagulant therapy
- Infection over the puncture area
- Do an X-Ray or confirm the fluid level by comparison of the dullness to percussion over the two lung fields
- Select the puncture site one or two interspaces below the fluid level in a posterior axillary line, but not lower than 8 intercostal spaces
- Place the patient on the edge of the bed, either with the arms lifted by an attendant or placed on two bulky pillows over the back of a chair
- Wear gloves an disinfect the puncture site. Local anesthetic is usually not necessary for a diagnostic puncture
- Draw down the skin and insert the needle along the superior margin of the inferior rib to avoid the intercostal nerves and blood vessels ; aspirate regularly to check for the location in the pleura
- Aspirate the specimen (5 mL)
- Remove the needle, and as the skin has been pulled down during the puncture, the channel will close by itself
- If iodine has been used as disinfectant , remove it with alcohol, apply a plaster
- Surgical gloves
- Sterile cotton swabs
- Skin disinfectant
- Syringe
- Needle
- Sterile specimen container(for microbiology) + citrate or EDTA tube (for cytology) + blood culture vial if possible (a pair or at least an anaerobic vial)
- Plaster