Pleural Aspiration

Authors: Dr Angus Chew*
                            Dr Stuart Lyon *

What is a pleural aspiration?

A pleural aspiration is a procedure where a small needle or tube is inserted into the space between the lung and chest wall to remove fluid that has accumulated around the lung. This space is called the pleural space.

Pleural aspiration is usually carried out to determine why there is fluid around the lung (diagnostic procedure) or to improve symptoms (therapeutic procedure), as the fluid around the lung may be causing symptoms such as cough, shortness of breath or chest pain.

How do I prepare for a pleural aspiration?

Do not eat or drink for 4 hours before the procedure. This is a routine precaution for many medical procedures. If you are diabetic, you should check with your doctor before fasting.

You may need to stop medications that thin your blood, as this may unnecessarily increase your risk of bleeding. Examples include warfarin (often sold as Coumadin or Jantoven), clopidogrel (often sold as PIavix), asasantin, heparin and enoxaparin sodium (often sold as Clexane). If you take any of these medications or have any concerns about whether or not to stop taking them, please discuss this with your radiology practice before the procedure.

Bring all of your usual medication(s) (or a complete list) with you when you attend for the procedure.

Bring with you, if possible, relevant films or CDs containing your previous imaging. This includes X-rays, ultrasounds, computed tomography (CT) scans or magnetic resonance imaging (MRI). It is common (but not essential) for people needing pleural aspiration to have had a chest X-ray, chest ultrasound or chest CT scan.

Make arrangements with a relative or friend to drive you home after the procedure.

What happens during a pleural aspiration?

A pleural aspiration is carried out whilst you are sitting upright on the side of a bed and leaning forward. You will usually be provided with a place to rest your arms so you can lean over comfortably.

The skin of your chest is washed with antiseptic and a very fine needle is used to administer local anaesthetic. The local anaesthetic stings for a few seconds before numbing the area.

A small cut is made in the skin and a needle or thin plastic tube is inserted into the space between your lung and chest wall to remove the fluid. The doctor may use an ultrasound to see the inside of your chest on a screen, as this can help find where the largest area of fluid is located.

Most frequently, this area is at the back of your chest or to the side. This is the reason why the doctor stands behind you while doing the pleural aspiration. You may be asked to hold your breath by the doctor who is carrying out the procedure.

Depending on the amount of fluid removed, a tube may be left in place whilst the fluid drains out.

After the procedure, the small opening in the skin is covered with a dressing.

A chest X-ray is usually carried out 2–4 hours after the procedure to assess for any complications. Complications are uncommon and are outlined in the ‘What are the risks of a pleural aspiration?’ section.

Are there any after effects of a pleural aspiration?

The area where the needle or tube has been inserted may feel a little tender for several days and there may be some bruising. If the area is painful, simple pain relievers, such as paracetamol (e.g. Panadol), may be helpful.

Your skin usually heals in a few days and you may have a tiny scar (typically less than 5 mm) at the site where the needle or tube was inserted.

How long does a pleural aspiration take?

The time taken for a pleural aspiration varies depending on how much fluid needs to be removed. It may take less than an hour or several hours. A chest X-ray is usually carried out 2–4 hours after the procedure and you will require medical supervision until this occurs. This X-ray is carried out to check for what is called a pneumothorax. A pneumothorax is a leak of air into the space around the lung (see the next section for more details).

What are the risks of a pleural aspiration?

There are some risks of a pleural aspiration that you should know about. Most of the more serious ones (pneumothorax, major bleeding from a large artery or vein in the chest, or fluid accumulation in the lung) occur at the time of or very soon after the procedure. This means they will be recognised while you are being observed in hospital or at the imaging facility.

Immediate risks of the procedure include:

• Air around the lung (pneumothorax) and collapse of the lung: When carrying out the procedure, air may enter the space around the lung via the drainage tube. Air may also leak from the lung tissue itself. This is called a pneumothorax and can occur in up to 30% of cases. If this is a small leak you do not need treatment. If it is a bigger one you may need a chest tube and to stay in hospital.
• Fluid build up in the lung: It is possible for fluid to collect in your lung and make you short of breath, particularly if a large amount of fluid is removed and your lung re-expands very quickly. This is an uncommon problem, but you may need to stay in hospital to have this treated.
• Injury to your liver, spleen or heart: There is a small risk of injury to your liver, spleen or heart. This is a very rare complication, particularly if an ultrasound is used to assist with the procedure, but it is potentially serious.

After you are allowed to leave, seek medical attention urgently immediately if you notice any of the following, as they may suggest a serious complication that requires immediate treatment:

• A lot of bleeding from the small cut in your skin.
• Increasing shortness of breath. This may include leakage of air around the lung that needs treatment in hospital.
• New or worsening pain whilst breathing deeply.
• A cough that produces blood.
• Infection: There is a small risk of infection. If infection does occur, it is usually very minor and can be treated with antibiotics.

What are the benefits of having a pleural aspiration?

A sample of the fluid that has been removed can be sent to a pathologist (a specialist doctor trained in analysing fluid) to determine why it has accumulated.

A pleural aspiration can make you feel more comfortable, as the fluid around your lung may be causing symptoms including shortness of breath, cough or chest pain.

Who does the pleural aspiration?

Many different types of doctors carry out pleural aspirations. It is commonly carried out by radiologists (specialist doctors), particularly if ultrasound guidance is used, surgeons, physicians and general practitioners.

Where is a pleural aspiration done?

A pleural aspiration is usually carried out in a hospital or large medical centre, as you will require monitoring throughout the procedure in a setting where medical staff will be available to treat you in the unlikely event of a complication.

When can I expect the results of my pleural aspiration?

If you are having fluid removed to relieve your shortness of breath, you can expect significant relief in the hours after the procedure.

If fluid is sent to a pathologist for further analysis, the time that it takes your doctor to receive a written report will vary depending on:

• the urgency with which the result is needed
• how the report is conveyed from the practice or hospital to your doctor (i.e. phone, email, fax or mail)

Please feel free to ask the staff where you are having your procedure when your doctor is likely to have a written report.

It is important that you discuss the results with the doctor who referred you, either in person or on the telephone, so that they can explain what the results mean for you.

Further information about pleural aspiration:

The results of a pleural aspiration are sometimes inconclusive. If this occurs, the aspiration may need to be repeated or alternative tests may be required.

*The author has no conflict of interest with this topic.

Page last modified on 26/7/2017.