Pleural effusion

Pleural procedures checklist

• USS guidance required
• Recent FBC (within 2 months) +/- Coag screen if indicated
• If on warfarin – withold till INR < 1.5. Rarely needs reversal. Check need for heparin cover if metallic valves / PE etc.
• NOACs will need to be withheld for 48 hours prior and Clexane for 24 hours.  In an emergency/urgent cases, discuss risk with patient
• Therapeutic aspirations / Chest drains needs a post procedure CXR
• Hand over to on call team if CXR done after hours

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Pleural fluid biochemistry

pH < 7.2 = empyema ——- Needs a chest drain!

Protein :

– < 25 g/dl – transudate

–> 35 g/dl – exudate

–25-35 g/dl either

Light’s criteria:   ( >=1 criterion makes it an exudate)

1. Pleural protein: serum protein >0.5

2. Pleural LDH: serum LDH > 0.6

3. Pleural LDH> 2/3 the upper limit of normal serum LDH

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Pleural fluid samples

Tests

Protein, Glucose, LDH  (5 mls in white top bottle)

pH (not for pus)

Culture & sensitivity / AFB (5 mls in white top bottle)

Cytology (50 mls)

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Chest Drain Management

Review chest drain monitoring chart

Review if bubbling/swinging

Ensure drain secure / apply additional dressings as needed

If in doubt – request senior review

Never clamp a drain unless advised by a senior

Do not apply suction unless advised by a senior

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