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Date issued: August 2022

Review date: August 2024

Ref: B-455 v2 pleural aspiration inpatient final August 2022 v2.pdf [pdf] 241KB

Pleural Aspiration

Information for inpatients

Provisional appointment date & time:                ________________________________

Your responsible (lead) consultant is:                ________________________________

Important information about your procedure

• Please tell the doctors and nurses looking after you about any medical conditions you have, and all the medication you take.

• Please tell us if you take any medication to thin the blood: these may need to be stopped before your procedure. You must continue to take any other medication as normal.

• Please seek medical advice if you develop any shortness of breath or increasing chest pain after your procedure.

Please sign and date below to confirm that you have read this information leaflet in full. You will have the opportunity to discuss any questions you might have about the procedure, or any other aspects of your treatment, with a doctor when you come to hospital for your appointment.

Signature:  __________________________________________________

Print name: __________________________________________________

Date: __________________________________________________

What is a Pleural aspiration?

The pleura is a thin skin that lines both your lung, and the inside of your chest cavity. The space between these two layers of skin is naturally lubricated by a small amount of fluid. In some patients the amount of fluid within the space can accumulate. There are many causes for this. To help narrow down the causes of excess fluid your doctor can take a sample of this fluid, using local anaesthetic to numb the surface of the chest wall. We analyse this sample in the lab. If you have a large volume of fluid in this space the doctor may also drain some of this away to help your breathing.

Why do I need a pleural aspiration? Are there alternative tests available?

Your doctor has recommended a pleural aspiration as the best way of finding out what is causing your illness, and/or to control any symptoms you might be experiencing. Your doctor will have considered this carefully, and made their decision with your best interests in mind. However, it is ultimately your decision as to whether or not you wish to have the procedure done.

Some patients may undergo a thoracoscopy to obtain a fluid sample and biopsies of the lining of the chest cavity. This is not the first investigation of choice as it is more invasive and may not be necessary, depending on the results of your fluid sample.

Because of the many causes of fluid in the chest cavity, some patients may prefer a trial of medication to control the fluid or a ‘watch and wait’ approach where your doctor would follow you up with subsequent imaging. However, this can cause delays in your diagnosis which may in turn, limit your treatment options down the line.

If you have any concerns or questions, please let your doctor know and they will be happy to discuss things with you in more detail.

How should I prepare for my pleural aspiration?

• Please let us know in advance if you are:

  • Pregnant

  • Taking medication to thin your blood

If any of these apply to you, we will need to make special arrangements for your procedure. These may include instructions as to what you should do with your medication.

• Please bring the following items with you on the day of your procedure:

  • reading glasses, if you need them

What should I do with my medications?

It is important to let us know in advance if you are taking medication to thin the blood. These will need to be stopped temporarily before your procedure can go ahead. Your procedure may need to be cancelled if you do not follow these instructions.

Please take your other medication as normal

The tables below explain what you should do with your medication in more detail. Please contact your doctor if you are not sure what to do. If your blood thinning medication cannot be stopped then your doctor may change it to an alternative medication temporarily, to enable the procedure to take place. The doctors on the ward will ensure the correct changes are made on your inpatient drug chart.

Blood thinning medications

Medication                             Instructions

Warfarin                                          Stop 7 full days before your procedure. You will need to have an INR blood test with your GP or at the hospital 1-2 days                                                                    before your procedure to make sure your INR is less than 1.5; otherwise we may need to cancel your procedure.

Aspirin                                            Stop 1 full day before your procedure.

 

Clopidogrel (Plavix)

Dipyridamole (Persantin)                 Stop 7 full days before your procedure.

Ticagrelor (Brilique)

 

Apixaban (Eliquis)

Dabigatran (Pradaxa)

Edoxaban (Savaysa)                       Stop 2 full days before your procedure. 

Rivaroxaban (Xarelto)

 

Dalteparin (Fragmin)

Enoxaparin (Clexane)                    Stop 1 full day before your procedure.  

Tinzaparin (Innohep)

What will happen on the day of my procedure?

You will be greeted by a member of the team who will check your observations (e.g. heart rate, blood pressure, temperature) and go through a checklist with you. This will include questions about your medical history, medications, and allergies.

A member of the team may take some blood tests if these have not been checked in advance. The procedure itself takes place on level 9 of the hospital. The procedure will be explained to you in more detail, and you will be asked to sign a consent form to confirm you are happy to go ahead. A member of the team will collect you from your ward and take you to the procedure room.

A doctor will do an ultrasound scan of your chest to help decide where to sample the fluid. This involves placing gel and a hand-held probe over your skin to create a picture on a screen. The ultrasound scan should not be painful. The doctor will then inject local anaesthetic into your chest wall – this may sting at first, but will soon numb the area so you do not feel anything during the procedure.

Once the area is numb, the doctor will be able to insert a needle into the fluid to take a sample. If the amount of fluid is large, a small tube (similar to a cannula) will be inserted along a needle into the space to drain the fluid away. Once the fluid has been drained and the sample taken, a plaster will be placed over the site. There is no need for a stitch.

The pleural aspiration usually lasts between 20 and 40 minutes.

What are the risks of the procedure?

Pleural aspiration is generally a very safe procedure, and serious complications are rare.

• Pain

You will experience pain in association with the procedure, but this is rarely severe. There is likely to be discomfort associated with the local anaesthetic and after the procedure the site may feel bruised. It is normal for your chest to be sore for a week or so after your procedure; this can be managed with painkillers. Some patients will feel their chest is tight and they may have a cough for a few days following the procedure, if a larger volume of fluid is drained. Your doctor will control the amount of fluid that is drained from your chest to minimise this side effect.

• Infection

There is a low but important risk of infection following a pleural aspiration. This can usually be treated with antibiotics, although it may sometimes need a chest drain to be inserted (a small tube) to empty the chest cavity of any infected fluid and therefore, can result in a hospital stay. Very rarely, infections can be more serious and need surgical treatment (an operation). Your doctor will take precautions during the procedure to ensure that this risk is minimised.

• Bleeding

A small amount of bleeding at the site of the procedure is normal. However, a small amount of people have significant bleeding during their procedure. This can usually be managed at the time of the procedure, but very rarely surgical treatment (an operation) is required.

• Pneumothorax

Your doctor will use an ultrasound scanner to locate the fluid for the procedure. However, there is a risk that the needle used to take a sample of the fluid, punctures the lung, causing it to collapse down. This is called a pneumothorax. Usually this doesn’t need any treatment but <5% will require insertion of a chest drainage tube to allow the lung to re-expand. This will require a longer hospital stay. Usually, this air leak will settle on its own, but rarely does it need a surgical procedure.

What happens after the procedure?

After the procedure a member of the team will take you back to the ward where you will have your observations (blood pressure, oxygen levels, heart rate and temperature) checked again. The team will also arrange for you to have a chest x-ray. If you are in any discomfort, we will give you painkillers to manage this. You must let your nurse and/or doctor know if your chest becomes increasingly painful or you feel increasingly short of breath.

When will the results of my procedure be available?

It will take 1-2 weeks for the results of your pleural aspiration to be ready. This is because it takes time for the specimens to be analysed. You will be given an appointment in the Chest Clinic to discuss the results with a doctor about 2 weeks after your procedure. If you are still an inpatient within the hospital at this time we will come to find you on your ward. Please contact your lead consultant’s secretary one week after your discharge if you have not received an appointment for the Chest Clinic unless you had your results explained before you left hospital.

How do I contact you?

If you have any questions or concerns, please contact:

Pleural Secretary:

Tel: (01752) 431496

Respiratory Fast Track Coordinators

Tel: 01752 763863

In the event of an emergency, please contact your on-call GP or NHS 111 for further advice