Performing a pleural tap is a skill that calls for precision, training, and confidence. The level of difficulty varies depending on several factors—such as the patient’s morphology (obesity, chest  deformities, etc.), their ability to cooperate, the volume of fluid, and of course, the practitioner’s experience.¹

To succeed, one must master clinical landmarks, adapt techniques to imaging, and have a strong understanding of anatomy to minimize pain and avoid complications.

For instance, the intercostal neurovascular bundle runs along the lower edge of each rib. If injured during the procedure, it can cause sharp pain, bleeding, or even a vagal reaction.²

That’s why inserting the needle just above the upper edge of the rib is crucial for safe and effective practice.³

Why simulation matters in learning pleural tap?

Pleural tap remains the only minimally invasive way to collect pleural fluid—making it an essential skill for healthcare professionals. Yet, training often still relies on the old model of “see one, do one, teach one.” As highlighted in the comic La vie de Carabin (2013), a medical student recalls performing his first pleural tap without proper training—causing unnecessary pain to the patient.

The French National Health Authority (HAS) has been clear since 2012: “never the first time on a patient.” Instead, simulation-based learning should be the standard.⁴

With simulation, students benefit from hands-on, risk-free practice, applying theory to realistic clinical scenarios.

They can repeat procedures, sharpen their anatomical knowledge, and understand the impact of poor positioning—turning mistakes into valuable learning opportunities. Simulation builds confidence, reduces stress, and prepares learners to perform pleural taps with control and care.

Sim&Care | Chest: Train Smarter with Augmented Reality

Why choose Sim&Care | Chest for training?

Our Sim&Care simulator is designed to make learning pleural tap both effective and engaging. With 3D anatomical models and biomechanical simulation, it replicates the true resistance of tissues during needle insertion—from skin to pleural cavity. It offers 3 fluid volumes and 2 thoracic orientations, so learners can adapt their technique to different clinical situations.

From lung ultrasound to the invasive procedure itself, Sim&Care guides learners step by step, developing both clinical reasoning and technical skills. Augmented reality adds an extra layer of safety and understanding, allowing users to visualize anatomical structures in transparency while practicing. The simulator also provides detailed feedback, highlighting strengths and areas for improvement—helping learners gain confidence with every session.

Pleural tap is both a common and vital procedure, bridging diagnosis and treatment. When performed correctly, it relieves the patient and guides the next steps of care. That’s why proper hands-on training is so important. By combining technical skill-building with immersive simulation, Sim&Care empowers students to train safely, reduce stress, refine their technique, and ultimately deliver higher-quality care with greater patient safety.

References

¹CHUM Health Literacy Center. (March 2025). Pleural puncture (Health Fact Sheet 1189). Montreal University Hospital Center (CHUM).

²Hospital Centre of Wallonie Picarde(CHwapi). (2019). Réalisation d’une ponction pleurale [PDF document]. CHwapi ASBL.

³Dezube, R., & Albert, R. K. (2025). Comment effectuer une thoracentèse. In Manuel MSD Professionnel. MSD Manuals.

⁴Mangiapan, G. (s.d.). Prise en charge de la douleur [PDF document]. French Language Pulmonology Society (SPLF).

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A pleural tap, also called thoracentesis, is a medical procedure recommended when there is an abnormal build-up of fluid in the pleural cavity. This condition is known as a “pleural effusion”. It can appear suddenly or develop gradually over time, often causing chest pain, a dry cough, and shortness of breath¹.

The procedure allows doctors to remove the fluid that has collected between the two thin layers of tissue, called the pleura, which protect the lungs.

Illustration of a pleural effusion
(Source: Healthdirect)

While thoracentesis is a common procedure, it is still technically delicate and can cause some anxiety for patients who are unsure of what to expect. Understanding its purpose, how it is carried out, and the possible risks can help you feel more at ease and better prepared.

Why is thoracentesis performed?

Thoracentesis is a frequently performed procedure in hospital settings, especially in pulmonology, internal medicine, oncology, and emergency care².

It has two main purposes:

• Diagnostic: to analyze the type of fluid present and determine its cause.

• Therapeutic: to relieve breathing difficulties caused by fluid build-up. In this case, the liquid is removed either with a syringe under local anesthesia or, if necessary, through chest drainage³.

How does the procedure work?

• To diagnose a pleural effusion, your doctor may use a physical exam along with imaging tests such as a chest X-ray, ultrasound, or CT scan. These help identify the amount of fluid and its exact location⁴.

• Once the diagnosis is made, no special preparation is required:

  • There is no need to fast

  • Hospital admission is usually unnecessary

  • The procedure typically takes about 15 minutes or longer, depending on the amount of fluid⁵

Illustration of the procedure
Source: Institut Mutualiste Montsouris, 2020

The procedure, step by step⁵:

• The patient will sit on the edge of a bed or chair, leaning slightly forward with your arms resting on a table.

• After numbing the area with a local anesthetic, the doctor makes a small incision.

• A fine needle or trocar is inserted between two ribs in your back to reach the pleural cavity.

• The fluid is then withdrawn with a syringe or drained into a bottle.

• A small dressing is applied afterward, and in some cases, a follow-up chest X-ray is prescribed.

Risks and possible complications

In most cases, a pleural tap is well tolerated. The use of imaging guidance greatly reduces the likelihood of serious complications. Still, as with any medical procedure, there are some risks to be aware of:

• Pneumothorax (collapsed lung): this can happen if air enters the pleural space because the needle touches the lung. Sometimes the air is reabsorbed naturally; in other cases, a chest drain is needed.

• Fainting: this can occur due to stress or if the patient has not eaten.

• Temporary dry cough: This may appear at the end of the procedure or a few hours later, caused by the lungs re-expanding. It usually doesn’t last long⁶.

References

¹Dezube, R., & Albert, R. K. (2025, revue et révision juillet 2025). Comment effectuer une thoracentèse [Entrée professionnelle]. Dans Manuel MSD Professionnel. MSD Manuals.

²Elsan. (s.d.). Épanchement pleural (Pleurésie) : définition, causes et traitements. Elsan.

³Elsan. (s.d.). Épanchement pleural (Pleurésie) : définition, causes et traitements. Elsan.

⁴Unité de Chirurgie Thoracique, Institut du Thorax Curie-Montsouris. (septembre 2020). Fiche : Épanchement pleural [Document PDF]. Institut Mutualiste Montsouris.

⁵Unité de Chirurgie Thoracique, Institut du Thorax Curie-Montsouris. (septembre 2020). Fiche : Épanchement pleural [Document PDF]. Institut Mutualiste Montsouris.

⁶Centre de littératie en santé du CHUM. (mars 2025). La ponction pleurale (Fiche santé 1189). Centre hospitalier de l’Université de Montréal (CHUM).

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