What is a pleural puncture?
During a pleural puncture, a fine hollow needle is inserted into the pleural cavity to remove accumulated fluid (pleural effusion). The pleural cavity is the narrow space between the two pleural sheets – the pleura visceralis, which lies directly on the lungs, and the pleura parietalis, which lies on the ribs on the chest wall.
A pleural effusion is also known colloquially as “water in the lungs”, although fluid has accumulated around the lungs (and not IN the lungs).
When is a pleural puncture performed?
A pleural puncture is performed when there is a pleural effusion. Such an accumulation of fluid between the two pleural sheets can have various causes, for example
- Inflammation (e.g. pleurisy, pneumonia, tuberculosis): This can cause an effusion with several liters of fluid to form in the pleural cavity, causing severe shortness of breath.
- Tumors: This can either be a primary tumor that has developed directly in the lung area or in the immediate vicinity (e.g. lung cancer, pleural cancer), or metastases from more distant primary tumors (e.g. colon cancer, prostate cancer).
- Liver failure (hepatic insufficiency): It can also cause pleural effusion, necessitating a pleural puncture.
- Kidney disease: Sometimes, for example, kidney weakness (renal insufficiency) is the trigger for an accumulation of fluid in the pleural cavity.
- Injuries in the chest area (such as rib fractures): These can lead to a bloody pleural effusion (haematothorax). If the injury is accompanied by a rupture of the body’s largest lymphatic vessel (thoracic duct) in the chest area, the result is a lymph-containing pleural effusion (chylothorax).
Pleural puncture may be performed for therapeutic reasons if the pleural effusion is so large that it is displacing the lungs and causing the patient breathing difficulties. The accumulated fluid can be removed via the puncture.
Sometimes a pleural puncture is also performed for emergency pressure relief in the case of a pneumothorax, i.e. when air has entered the pleural cavity, causing the negative pressure to be lost. This can happen, for example, in the case of injuries in the chest area (stab or gunshot wounds, rib fractures, etc.) or various diseases (such as COPD).
What is done during a pleural puncture?
Before the pleural puncture, the doctor checks the pleural effusion using ultrasound to estimate the approximate amount and possible puncture site. A blood sample provides information on whether the patient suffers from a coagulation disorder – this could cause complications such as severe bleeding during the puncture.
To ensure that the effusion collects completely in the area of the diaphragm and thus facilitates the removal, the patient normally sits during the pleural puncture, with the upper body slightly bent forward and supported by the arms. However, if the patient’s movements are restricted, a pleural puncture can also be performed with the patient lying down. The doctor generally chooses the deepest possible puncture site in order to be able to aspirate as much fluid as possible.
The doctor first disinfects the puncture site, wraps it in a sterile drape and injects a local anaesthetic so that no pain is felt during the puncture. General anesthesia is not necessary; however, anxious patients may be given medication to calm them down.
After a few centimetres, the needle is located in the pleural cavity: the fluid can now be aspirated using a syringe. The doctor then withdraws the syringe. The small wound then usually closes by itself and is covered with a plaster.
What are the risks of a pleural puncture?
In rare cases, the following complications can occur during a pleural puncture:
- Bleeding at the puncture site (especially in the case of unrecognized coagulation disorders)
- infections
- Injury to neighboring organs or tissue structures (such as lungs, diaphragm, liver, spleen)
- Pulmonary edema and possibly a new pleural effusion (if the effusion is aspirated too quickly, resulting in negative pressure in the pleural cavity)
What do I need to consider after a pleural puncture?
After a pleural puncture, you should watch out for pain and possible post-operative bleeding in the area of the puncture site. If you experience shortness of breath or severe pain again, you must inform your doctor immediately. Sensory disturbances and tingling in the rib area after a pleural puncture should also be noted as a warning signal.
