• Therapeutic drainage of pleural effusion in patient
with respiratory compromise when fluid is unlikely to reaccumulate.
• Diagnostic evaluation of pleural effusion of unknown etiology.
• Therapeutic removal of small pneumothorax.
• Skin infection (eg, herpes zoster) at site of
• Bleeding diathesis, anticoagulant therapy.
• Mechanical ventilation.
• Sterile gloves, mask, and gown.
• Iodinated skin preparation with sterile sponges.
• Sterile towels.
• Local anesthetic (1% lidocaine without epinephrine).
• 5-mL syringe with 25-gauge needle.
• 18-gauge 2-inch needle.
• 18–20-gauge angiocatheter.
• Collection basin.
• 3-way stopcock.
• 20–60-mL syringe.
• Laceration of lung or other underlying tissues.
• Potential for need to remove additional fluid or air at a later
• If fluid or air is likely to reaccumulate, then tube thoracostomy
• In a cooperative child, the procedure does not
take more than 10–15 minutes.
• Use lateral decubitus film to determine whether pleural effusion
is free-flowing fluid or loculated.
• Insert needle over top of rib since the neurovascular bundle
is under the rib (see Figure 20–1).
Anatomy of the neurovascular bundle.
• Patient should have intravenous access.
• Oxygen should be available.
• Monitor oxygen saturation with pulse oximetry.
• Younger patients may need sedation for procedure.
• Explain procedure in a developmentally appropriate manner before
and during procedure.
Patient positioning for pleural effusion.
Patient positioning for pneumothorax.
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