Choose insertion site/positioning
Upright position in mid-scapular or posterior axillary line (usual technique)
Lateral decubitus position with fluid side down in post axillary line (if cannot sit up)
Supine with head elevated as much as possible in midaxillary line (chest tube location)
Cleanse skin with chlorhexidine or betadine
Anesthetize skin and subcutaneous tissue - raise wheal and advance/inject along superior aspect of lower rib (avoid NV bundle)
Make small skin nick with scalpel
Insert/advance needle while continuously aspirating until pleural space is entered
Advance catheter into pleural space while removing needle
Connect tubing to catheter and to evacuated container and remove desired amount of fluid
Upright position in mid-scapular or posterior axillary line (usual technique)
Lateral decubitus position with fluid side down in post axillary line (if cannot sit up)
Supine with head elevated as much as possible in midaxillary line (chest tube location)
Obtain post-procedure CXR if:
Multiple needle passes required
Air is aspirated
Risk of adhesions
New-onset of symptoms during the procedure (chest pain, dyspnea)
Patient at high risk for decompensation from small pneumothorax (lung disease, positive pressure ventilation)
Multiple needle passes required
Air is aspirated
Risk of adhesions
New-onset of symptoms during the procedure (chest pain, dyspnea)
Patient at high risk for decompensation from small pneumothorax (lung disease, positive pressure ventilation)
Thoracentesis
Thoracic lavage
Thoracotomy
Thoracotomy 
Needle thoracostomy
Pulmonary antibiotics
Paracentesis
Finger thoracostomy