Drain Declamping

1. Confirm presence of effusion by CXR or ultrasound.

2. Select drainage site either by maximum area of stony dullness under percussion or under ultrasound guidance.

3. Use aseptic technique. Clean area with antiseptic and infiltrate local skin and subcutaneous tissues with 1% lidocaine. Advance into deeper tissues, aspirating to confirm absence of blood then infiltrating with local anaesthetic until pleura is pierced and fluid can be aspirated.

4. Advance drainage needle/cannula/drain slowly, applying gentle suction, through chest wall and intercostal space (above upper border of rib to avoid neurovascular bundle) until fluid can be aspirated.

5. Withdraw 50ml for microbiological (M, C&S, TB stain, etc.), biochemical (protein, glucose, etc.) and histological/cytological (pneumocystis, malignant cells, etc.) analysis as indicated.

6. Either leave drain in situ connected to drainage bag or connect needle/cannula by 3-way tap to drainage apparatus.

7. Continue aspiration/drainage until no further fluid can be withdrawn or if patient becomes symptomatic (pain/dyspnoea). Dyspnoea or haemodynamic changes may occur due to removal of large volumes of fluid (>1-2l) and subsequent fluid shifts; if this is considered to be a possibility, remove no more than 1l at a time either by clamping/declamping drain or repeating needle aspiration after an equilibration interval (e.g. 4-6h).

8. Remove needle/drain. Cover puncture site with firmly applied gauze dressing.

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