PLEURAL ASPIRATION OF AIR

• Treatment of pneumothorax
• see Spontaneous pneumothorax guideline for when to use technique

• Pleural aspiration pack (if available)
• Otherwise use:
• cannula with 3-way tap and 50 mL syringe
• cleansing pack
• gloves
• gown
• lidocaine 1–2% plain maximum 10 mL

• If not competent in procedure, organise supervision by a clinician experienced in the procedure

Consent

• Explain procedure and reassure patient
• Obtain and record written consent
• Complete WHO surgical procedure checklist

Site of insertion and position of patient

• Check site of entry on most recent chest X-ray
• If no adhesions, use second intercostal space in mid-clavicular line
• axillary approach is an alternative
• Support patient with head of bed elevated to about 30°
• if axillary approach chosen, arm behind head

Aseptic technique and local anaesthesia

• Scrub up and prepare patient's skin
• Infiltrate local anaesthetic down to pleura
• Aspiration of air confirms pneumothorax

Insertion of cannula

• Enter pleural cavity with cannula attached to a 10 mL syringe
• Withdraw needle from cannula when air is freely aspirated
• Connect cannula via plastic tube to 3-way tap and a 50 or 60 mL syringe or use needle aspiration kit
• Withdraw air until no more can be aspirated or to a maximum of 2.5 L (50 mL x 50) whichever is achieved first
• STOP if resistance is felt or patient coughs excessively
• If resistance is felt when only a small amount of air has been aspirated, cannula may be kinked: remove it and repeat procedure

• Apply small adhesive dressing over puncture site
• Repeat chest X-ray
• if pneumothorax smaller or resolved, aspiration successful
• If unsuccessful, consider chest drain