Pleural Puncture

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Pleural Puncture
Pleural Puncture

Video: Pleural Puncture

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Video: Pleural puncture (Thoracocentesis) 2023, January
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Pleural puncture

During a pleural puncture, fluid that has accumulated in the course of pathological processes is removed from the pleural space (a space between the pleura and the lungs). The puncture is primarily used for diagnosis, but can also be used for therapeutic purposes. In addition, a puncture or drainage is performed to remove air from the pleural space for a pneumothorax.

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  • When is a pleural puncture necessary?
  • What preparations are necessary?
  • How does a pleural puncture work?
  • What are the side effects / complications?
  • Whom can I ask?
  • How are the costs going to be covered?

When is a pleural puncture necessary?

A pleural puncture may be necessary for the following reasons:

  • Clarification of the causes of effusions in the pleural space or
  • Performed as part of a therapy.

When clarifying the causes of effusions, it is important to differentiate between a transudate (clear, low-cell liquid, total protein content below 30 grams / liter) and an exudate (cell-rich, total protein content above 30 grams / liter). It is based on the protein content of the liquid compared with the protein content in the blood (30 grams / liter).

Reasons for a transudate can include:

  • Heart failure,
  • Hypoalbuminemia (in severe liver and various kidney diseases).

The reasons for an exudate are inflammatory processes on the pleura. Causes can include:

Infections like

  • Pneumonia (inflammation of the lungs)
  • Pleurisy (bacterial pleurisy)
  • Tuberculosis.

Immunological / inflammatory processes, e.g. in:

  • rheumatic diseases,
  • Pulmonary embolism (pulmonary embolism)
  • Pancreatitis,.

Caused by malicious processes:

Metastases from tumors on the pleura (e.g. in bronchial or breast cancer)

A pleural puncture may be indicated as part of a therapeutic measure for the following reasons, among others:

  • to "let out" liquid or air in the case of larger effusions
  • to be able to perform a drainage,
  • in connection with a pleurodesis (“sticking” of the pleura through medication), eg with malignant effusions or a pneumothorax.

What preparations are necessary?

The patient's state of health is clarified in advance of the planned operation. Various examinations are carried out (e.g. x-rays, ultrasound, blood clotting). Among other things, the medical history with illnesses, allergies, taking medication (e.g. blood thinners) etc. is essential. Some of these are already known in advance. Before the planned pleural puncture, the doctor will inform you about the procedure and how it will proceed. Open questions can also be clarified in the conversation.

How does a pleural puncture work?

The puncture or drainage of a pneumothorax is usually carried out in the supine position or sitting from the front just below the collarbone.

An effusion is usually punctured or drained from behind or from the side as close as possible above the diaphragm. The samples are used for further examination in the laboratory. Various values ​​such as proteins, PCR and microbiological and cytological laboratory tests are recorded. For more information, see Laboratory Values ​​Table.

Puncture of an effusion

The puncture can be performed in a seated position, ie with the upper body bent slightly forward and exposed. The patient can support himself / herself on the back of a chair, table or pillow, for example. The pleural puncture may also be performed in the lateral position (e.g. if you are bedridden).

The doctor locates the puncture point between two ribs (usually using ultrasound or percussion) and marks it. The skin area is shaved if necessary and then covered with a sterile layer. The doctor works with a face mask, hood, sterile gloves and sterile material. The patient may be given medication to calm or suppress the coughing stimulus. A local anesthetic is injected into the muscles in the marked intercostal space, then the puncture needle is carefully advanced into the pleural space and the fluid is collected, eg in a sterile tube or a collection bag. It can also be drawn up with the syringe.

At the end of the sample collection, the needle is removed, the puncture area is provided with a sterile plaster and, if necessary, a compression bandage is applied. A control x-ray is taken.

Drainage of an effusion

A pleural drainage is carried out in the same way: Here, after the muscles have been anesthetized, a thin tube (about three millimeters in diameter) is inserted into the pleural space using a guide needle. Samples are then also taken.

What are the side effects / complications?

If you suffer from blood clotting disorders, it is essential that you tell the doctor so that a blood clotting test can be carried out before the puncture. Complications such as pneumothorax, infection, bleeding, injuries to organs (liver, spleen) can occur.

Whom can I ask?

A pleural puncture is usually performed in the hospital (pulmonology, thoracic surgery). Depending on the situation, an admission or referral certificate from your treating doctor is required. For more information, see Well prepared for the hospital.

How are the costs going to be covered?

The costs for a pleural puncture are usually covered by the responsible health insurance provider. For more information on costs for a hospital stay, see What does a hospital stay cost?

Your doctor will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB). You can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic. For more information, see Visit a Doctor: Costs and Deductibles.

For information on the respective provisions, please contact your health insurance provider, which you can find on the social security website.

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