Sunday, April 11, 2021




Written Informed Consent, Sterile gloves, povidone iodine solution, aspiration needle, 3 way stop cock, one 5 mL (for LA) and one 20 mL or 50 mL syringe, a reservoir (empty plastic bottle), one non-collapsible tube (iv set can be used for this), injection lignocaine and sterile dressing


1. Check the vitals of the patient.

2. Position of the patient

(Sitting leaning forward with hands on the table)

  • If no table is available, ask the patient to cross their arms in front of their chest.
  • If the patient is unable to sit up, the lateral recumbent or supine position may be used. 


  1. IV access should be established before procedure in most cases. 

  2. Atropine should be on hand in case of profound vaso-vagal response and supplemental O2 should be administered throughout the procedure. It is given as IM routinely pre-procedure. 

  3. Confirm the side by looking at the chest radiograph or sonography report) 

  4. The skin at the puncture site will be cleansed with an antiseptic solution like povidone iodine. 

  5. SITE: 7th or 8th intercostal space between the inferior angle of scapula (Aspiration site is determined by USG when done electively or by percussion when done during emergency.)  

  6. Give local anesthesia. Infiltrate the skin and subcutaneous tissue and the parietal pleura over the chosen space at the upper border of the lower rib.   

  7. The needle has to be inserted near the upper border of lower rib in the intercoastal space.

  8. Insert the needle with the stop cock in closed position piercing the skin, subcutaneous tissue and the pleura. A 20 or 50 mL syringe is connected to the end of the stop cock and by turning the stop cock to on position, fluid is aspirated gently with the syringe (figure 1). The stop cock is turned on to the side channel and the fluid is pushed out from the syringe to the reservoir (usually a plastic bottle) via the side channel (figure 2). The process of aspiration is then repeated by turning the stop cock to on position. 


Figure 1- Showing the position of the 3-way during aspiration of pleural fluid

Figure 2- Showing the position of the 3-way while pushing out the fluid into reservoir

Not more than 1000 mL of fluid from pleural cavity is removed within first 30 minutes if done for therapeutic purpose (to prevent re-expansion pulmonary edema). 40-50 mL fluid is sufficient if done for diagnostic purposes. The fluid may be sent to a laboratory for testing (pleural fluid analysis). 

Place a small sterile dressing over the site of puncture.


10. Post-procedure X-ray to evaluate the fluid level.




Written by our guest authors - Aishwarya Bagade and Ayushi Gupta 

Illustration by Anveshi Nayan 




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