Information on Pleural Tapping Procedure, Preparation, Complications and Results

Submitted on March 27, 2012

A pleural tap procedure involves the removal of fluid from the area between the chest cavity and the tissue lining of the lungs. This area is known as pleura. A small amount of fluid is normally present in this area as it is required for the lubrication of the pleura. However, in some cases there is a build up of excess fluid between the layers of the lung lining or pleura. This condition is referred to as pleural effusion. Pleural effusions may be of two types, transudative pleural effusions and exudative pleural effusions. Transudative effusions result from the leakage of fluid into the pleural area caused by a rise in pressure or low protein level of the blood vessels. The most common cause of this condition is congestive heart failure. Exudative effusions result from leakages in the blood vessels due to inflammation of the pleura. The common causes of this are lung disease such as cancer or infections such as pneumonia and tuberculosis.

Bag-like membranes called pleura line the chest cavity and envelope the lungs. Normally, fluid is present in minute quantities so as to the keep the pleura walls lubricated. Pleural effusion is a condition when there is an abnormal volume of fluid in this pleural space. A pleural tap is performed to remove excess fluid accumulated between the chest wall and the pleura. There are two types of pleural effusions, depending on where they occur.

  • Transudative pleural effusion: This occurs when excess fluid seeps into the pleural space.
  • Exudative pleural effusion: This occurs when excess fluid seeps out from the weak veins, typically due to inflammation.

Symptoms of Pleural Effusion

The symptoms of pleural effusion are very noticeable and the patient would experience chest pain, breathlessness, hyperventilation or erratic breathing, fever, cough, and weight loss. Smoking and occupational hazards like exposure to asbestos are most likely causes. Chest X-rays, CT scans, or pleural tap tests determine the presence of fluid (whether transudative or exudative).

Causes of Pleural Effusion

The common causes of pleural effusion can be broadly classified into two categories based on the type of the pleural effusion.

Transudative pleural effusion

  • 'Congestive' heart failure. This is when the left ventricle in the heart stops functioning.
  • Mitral valve problems
  • Liver disease
  • Kidney problems
  • Excess fluid in chest cavity and pleura
  • Ovarian tumor
  • Block in the super vena cava due to lung cancer

Exudative pleural effusion

  • Pneumonia
  • Breast cancer in woman
  • Lung cancer in men
  • Rheumatoid arthritis
  • Pancreatitis
  • Autoimmunity
  • Heart problems
  • Tuberculosis
  • Fungal infections
  • Exposure to toxic substances like asbestos
  • Intolerance to certain drugs

Treatment for Pleural Effusion

Once the doctor has determined the condition is due to transudative or exudative pleural effusion, the first step in treatment involves removal of excess fluid. The second step is to make sure the fluid does not seep into the cavity or the lungs. The last step in the treatment for pleural effusion is to diagnose the condition and put the patient on the right treatment regime.

If the condition is a result of excess fluid causing pressure on the lungs and making breathing difficult and traumatic, the immediate course of action is theurapeutic thoracentesis. Removal of the fluid will ease the pressure on the lungs and allow the patient to breathe normally.

Pleural effusion as a result of cancer is drained through a chest tube. Pleural effusion due to infections is treated with relevant antibiotics. Pleural effusion caused by heart problems is treated with diuretics, and in many cases, with drugs to heal the heart. Once the fluid has been drained out, introducing drugs into the chest cavity will help prevent any further accumulation. In some dire cases, surgery may be required. However, this is normally only in extreme cases if the doctor feels that there is no other way to treat problem.

Technique Involved

The pleural tapping procedure is performed under strict clinical conditions by an experienced professional. The pleural tapping technique first involves an X-ray or ultrasound to identify the exact site of fluid accumulation. A local anaesthetic is given to the patient. He is asked to sit upright bending slightly forward. A hollow pleural tap needle or cannula is slipped between the ribs through the patient's back and the fluid so collected is sent for analysis. A sterile dressing is applied on the site of puncture followed by a chest X-ray.


Pleural tap complications include:

  • Fainting
  • Coughing
  • Breathlessness
  • Bleeding
  • Infection
  • Lung edema or fluid build-up
  • Lung collapse


A pleural effusion tap is conducted to determine the cause of the fluid buildup. It is also done to reduce the symptoms caused by the accumulation of fluid.


There is no advance preparation required for this procedure. In some cases, an X-ray of the chest may be done prior to or after the pleural tap test. During a pleural tap, the individual must not move, breathe deeply or cough as this may pose a risk of injury to the lungs.


The individual is made to sit on a bed or on a chair with his head and arms placed on a table. The area around the site of the procedure is first disinfected and then draped. Local anesthesia is administered to the area. An instrument known as a thoracentesis needle is inserted into the pleural space. Slight pressure may be experienced when the needle is inserted into the pleural area. Fluid is drawn from the area and the sample is sent for analysis to the laboratory.


Abnormal test results may be indicative of infection, heart failure, cancer, kidney disease or cirrhosis. If the cause of pleural effusion is suspected to be infection, a culture of the withdrawn fluid is conducted to determine the presence of microorganisms. Other conditions which may require the performance of a pleural tap include pancreatitis, pneumonia, hemothorax, thyroid disease, pulmonary embolism and drug reactions.


Only a trained professional will be able to provide you with proper pleural tap interpretation. The amount of protein in the fluid sample determines if it is transudative (below 30g/L) or exudative effusion (above 30g/L).

Further indicators are as follows:

  • Blood in the sample fluid indicates cancer, heart damage, and asbestos intolerance
  • Abnormal pH levels indicate lung infection, rheumatism, TB, and cancer
  • Abnormal amount of white blood cells indicate TB and cancer

At times, there are also abnormal levels of cholesterol, triglycerides, and glucose.