Pleural Tap

In Nov 2011, when I went for a pleural tap or chest tap for my pleural effusion, the hospital gave me some information on pleural tap.

Pleural cavity is the potential space between the chest wall and the lungs.  This space may be filled with fluid or air.

A pleural tap involves inserting a needle into the pelural cavity to draw out the fluid that has accumulated within this space.

This procedure may be done to diagnose a patient's condition in which case the fluid drawn may be sent for tests to detect infection or cancer cells.  It may also be done to relieve the breathlessness a patient feels as a result of the fluid accumulation.  (Note in my case, it was mostly done to relieve breathlessness and sometimes the fluid drawn was sent for tests as well.)

The patient will normally be sitting up during the procedure and usually leaning forward on a pillow on the side table.  Local anaesthesia is injected into the site on the chest wall where the needle will be inserted.  This site is usually at the back or side of the chest wall.  The needle is then inserted in between the ribs, through the chest wall into the pleural cavity.  Fluid is then drawn out.

Risks of a pleural tap
(figures based on Seneff et al Chest 1986 Jul; 90 (1); 97-100)

Pneumothorax

This occurs in about 10% of procedures.  This occurs because air is leaking from the lung that is punctured during the procedure.  The check Chest X-ray will be done to ensure this has not happened.  If this complication occurs, the patient may need to stay in hospital and have a chest tube inserted to drain out the air that is leaking from the lung.

Bleeding

There is usually minimal or no blood loss during the procedure but significant loss may occur if there are clotting abnormalities.  Precautions will be taken prior to the start of the procedure to ensure that blood loss is limited to the minimum.  Occasionally, a chest will artery known as the intercostal artery may be lacerated during the procedure and bleed into the pleural cavity resulting in a condition known as haemothorax.  The reported incidence is less than 1%, but the patient will require further treatment for such a complication.

Splenic/Liver Laceration

Is reported that in less than 1% of cases, the liver or spleen may be lacerated.  This is a serious complication, which may result in severe blood loss in the intra-abdominal cavity.  Open surgery may be needed to stop the bleeding.

Minor complications

The patient may cough more after the procedure as a result of the lung re-expansion.  This occurs in about 10% of cases.  A dry tap (that is, no fluid is drained) may be encountered in about 13% of procedures.  A blood clot or cluid collection may arise under the skin post procedure in about 1-2% of cases but they are expected to resolve with time.