Last Updated on August 19, 2026
Introduction
-
Therapeutic
×
Symptomatic relief by removing pleural effusion
-
Diagnostic
×
Fluid collected are sent analysis for diagnostic purpose
If pleural effusion is massive If pleural effusion is poorly defined clinically
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– Can be done
clinically
Contraindications
- Uncooperative patients
- Bleeding tendency (INR >2 or Platelet <50)
- Local skin infection
Equipment
- 3-way cock stopper
- IV drip set
- Branula (e.g. green)
- Sterile towel
- Disposable sterile set
- Chlorhexidine
- Lignocaine
- CBD bag
Landmarks
- Posterolateral aspect of the chest wall (midscapular or posterior axillary line), 1–2 intercostal spaces below the percussed upper border of the effusion OR 5 – 10 cm lateral to spine
-
Above diaphragm
×
Not lower than 8th intercostal space
Notes
Drainage
- Maximum: 1 liter – 1.5 liters for immediate symptomatic relief
- Subsequently, patient can be referred to
IR
for pigtail insertion for further drainage of the pleural effusion.×IR
Abbreviation: IR
Interventional radiology
- Target e.g. 500 mL per shift (≈1.5 liter per day)
Investigations
• The following investigations are sent in the same setting of pleural tapping
• Pleural fluid will be classified as exudative or transudative, following Light’s criteria
(i) Pleural fluid
Usually, these are the common investigations sent for pleural fluid:
-
Cytology
×
The sensitivity of cytology of pleural fluid in detecting malignancy is ≈58%, i.e. only ≈ 58% of patients with malignant pleural effusion can be detected by cytology of pleural fluid.
- C&S
- FEME
- Biochemistry (pH, glucose,
LDH
, protein)×LDH
Abbreviation: LDH
Lactate dehydrogenase
=====
Notes:
• Serum LDH is marker for haemolysis
• LDH is part of Light's criteria in pleural effusion
• LDH is also used as cardiac enzyme (together with CK + AST), especially in district hospitals where Troponin / CK-MB is not immediately available
- AFB
- MTB C&S
(ii) Blood
-
Liver function test
×
To look for serum protein level
- Serum
LDH
×LDH
Abbreviation: LDH
Lactate dehydrogenase
=====
Notes:
• Serum LDH is marker for haemolysis
• LDH is part of Light's criteria in pleural effusion
• LDH is also used as cardiac enzyme (together with CK + AST), especially in district hospitals where Troponin / CK-MB is not immediately available
(iii) Imaging
- Chest X ray post thoracocentesis