Pleural Aspiration

Introduction

This leaflet is for patients who are to undergo a diagnostic or therapeutic pleural aspiration.

What is a pleural aspiration?

A pleural aspiration is a procedure to remove fluid from the space between the lung and the inside of the chest wall. A diagnostic pleural aspiration takes a small amount (usually 20 to 100ml) of fluid to allow for tests to be performed on the fluid. A therapeutic aspiration removes a larger amount (up to 1.5 litres) to improve breathlessness. We often do both a diagnostic and therapeutic aspiration at the same time.

Why do I need a pleural aspiration and what are the benefits?

When you take a breath in, your lung follows the inside of your rib cage as it moves, but they are not stuck together. There is a double layered covering (“the pleura”), rather like “cling film”, between the outer surface of the lungs and the inside of the rib-cage. It is lubricated and allows the lungs to move with the rib cage when you breathe in and out.

In your case fluid has built up between these layers and this is limiting how much your lung can expand. This may be making you breathless.

The build-up of fluid is called a “pleural effusion”. By removing fluid by doing a pleural aspiration your doctors can try and work out why the fluid has built up and, depending on the amount removed, help improve your breathlessness.

Why has the fluid accumulated?

There are several reasons for this fluid to accumulate, with examples listed below. Your doctor may be able to be more specific in your case, but they will often need a sample of the fluid to help work out why.

• Infection, including pneumonia or occasionally tuberculosis.
• Irritants between the pleural membranes, notably asbestos fibres.
• Cancerous deposits between the pleural membranes.
• As a result of processes affecting the function of other organs, such as heart failure or kidney disease.
• Inflammation of the pleural membranes in conditions such as Rheumatoid Arthritis.

What are the risks of a pleural aspiration?

This is a very safe procedure, but as with any medical procedure there are potential risks which your doctor will explain.

• The most common risks are pain, bleeding, and introducing infection.
• Less commonly the needle may accidently puncture the lung or other organ such as the liver or spleen. We significantly reduce this risk by using an ultrasound machine to find the best position to place the needle.
• Serious complications are very rare, but some people require hospital admission after the procedure.

Preparing for the procedure

Your doctor will arrange for some simple blood tests to make sure you are not at high risk of bleeding. The procedure is usually performed as a day case in Lung Health at the University Hospital of North Tees.

You can drive yourself, although it is often best to have someone bring you and stay with you while you are in the clinic. You can eat and drink as normal for this procedure and you should take all your usual medications unless told not to by the team.

If you are on blood thinning medications (e.g. warfarin, tinzaparin, enoxaparin, rivaroxaban, or apixiban) you will be given specific instructions which may involve stopping the medication; if you are unclear about this please contact the team.

How is the procedure performed?

The doctor performing the procedure on the day will explain the whole procedure to you and ask you to sign a consent form. After this the team will place you in a comfortable position allowing the doctor access to your chest – often by asking you to sit on a chair with you comfortably leaning over a couch with a pillow on.

The procedure is as follows:

• The doctor will use an ultrasound to find the best place to get the fluid.
• The site will then be cleaned to kill any bacteria on your skin with an alcohol gel, which may feel cold.
• The area will then be numbed by injecting local anaesthetic in the skin and into the chest wall. A small needle is used for this which will feel sharp, and you may feel a stinging sensation just before the anaesthetic starts working.
• Once numb, the doctor will pass a needle into the area to obtain the fluid. You may feel a sharp pain as the membrane is punctured, in which case we will give a little more local anaesthetic.
• If a therapeutic aspiration is being performed, a very small plastic tube is passed over the needle into the space between the membranes where the fluid has built up. This is then connected to a bag to allow the fluid to come out over a period of 20 minutes or so.

As the fluid is removed, your lung will start to re-expand and you may want to cough. This is normal and it is safe to cough.

What happens after the procedure?

Once the needle is removed, a small plaster is placed over the site – this can be removed after 24 hours.

The nursing staff in Lung Health are very experienced and will look after you for the next 30 minutes. They may need to check your blood pressure during this time. If you feel unwell in any way please let them know. If directed by the doctor they will arrange for a chest X-ray to be taken during this period.

Sample results usually take 7 to 10 days to be processed and you will be seen in the clinic to discuss these.

If you have been referred to the respiratory team by another consultant then results might go directly to your referring consultant.

Aftercare advice

This is a very safe procedure with few risks and it is rare for problems to occur after.

If you develop pain which is not responding to standard painkillers or you develop increasing breathlessness in the hours after the procedure you should contact Lung Health (9am to 5pm), or out of hours medical care (GP, ‘111’ service, or emergency services if you are feeling very unwell).

Contact Numbers

North Tees and Hartlepool NHS Foundation Trust

Lung Health

Telephone: 01642 624270

9.00am to 5.00pm

Department of Respiratory Medicine

Telephone: 01642 624936

9.00am to 5.00pm

NHS Choices

Telephone: 111 (when it is less urgent that 999)

Calls to this number are free from landlines and mobile phones or via the website at www.nhs.uk

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]