• 
  

  • 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.

Relative

• 
  

  • Skin infection (eg, herpes zoster) at site of insertion.

  
  

  • 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.

• 
  

  • Bleeding.

  
  

  • Laceration of lung or other underlying tissues.

  
  

  • Potential for need to remove additional fluid or air at a later time.

  
  

  • If fluid or air is likely to reaccumulate, then tube thoracostomy is indicated.

• 
  

  • 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).

• 
  

  • 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.

• 
  

  • Pleural effusion.

  
  
  
  
  • 
    

    • Sitting upright with arms supported on table in front of patient (see Figure 20–2).