Jane Sturgess - Applied Anatomy for Clinical Procedures at a Glance

1 If the fluid/air you hope to drain is at high pressure or high volume it will automatically flow to the outside – take care if this is unplanned, or you wish to drain only a predetermined amount (e.g. pleural effusion, CSF, ascites). Be prepared to replace large fluid losses with the appropriate intravenous replacement fluid (blood, albumin, crystalloid).

2 If the fluid/air you hope to drain is at low pressure (negative intrapleural pressure on inspiration, or central vein with three‐way tap system above the level of the heart) or low volume, fluid may flow into the patient inadvertently causing complications such as pneumothorax or air embolism – take care.

3 Using a syringe to aspirate a low volume, low pressure system can collapse the tissues if too great a negative pressure is applied. This can either make the drain or line fail or give a false negative result to your aspiration, leading to unnecessary repeated tests (with associated risks) or a false diagnostic conclusion (with associated risks, and delay in diagnosis).

1 Look at the tap and plan how to turn it before you start – which ways do you need fluid/air to flow and at what time points of the procedure?

2 Plan how to stop flow – you can either turn the tap so that the top of the T with no arm faces the direction you want to stop flow from (usually the patient); you can put a bung onto the Luer lock that has an arm with an arrow pointing towards it; or you can quarter turn the tap so that none of the arms point towards a line – it will lie at an angle to the giving system.

3 If aspirating low volume or low pressure fluid consider using a small syringe in the first instance and be prepared with a choice of larger syringes. It is easy to switch to a larger syringe during the procedure if the fluid/air flows easily.

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