What does it mean when a healthcare provider says they may have to aspirate a patient?

What Does "Aspirate the Patient" Mean?

When a healthcare provider says they may have to "aspirate" a patient, they are referring to the removal of fluid or secretions from the body using a needle or subing device—most commonly from the airway/lungs (pulmonary aspiration management), joints, or body cavities. The specific meaning depends entirely on the clinical context.

Most Common Medical Meanings of "Aspiration"

1. Airway/Pulmonary Aspiration (Most Common in General Medicine)

This refers to when food, liquid, saliva, or stomach contents accidentally enter the airway and lungs instead of going down the esophagus to the stomach. 1

Key clinical signs that indicate aspiration has occurred: 2, 1

• Coughing during or after eating/drinking (hallmark sign)
• Wet or gurgly voice quality after swallowing
• Wheezing or increased respiratory secretions
• Choking episodes during meals

High-risk patients who may need aspiration evaluation: 2, 1

• Stroke patients (84% of aspirators have weak or absent voluntary cough)
• Patients with reduced consciousness or lethargy
• Those requiring frequent oral/pharyngeal suctioning
• Patients with dysarthria (slurred speech) or dysphonia (voice changes)
• Anyone with unexplained chronic cough

What the provider may do: 2, 1

• Perform bedside water swallow test (3 oz of water while observing for cough, wet voice, or choking)
• Order videofluoroscopic swallow study (VFSS)—the gold standard diagnostic test
• Refer to speech-language pathologist for formal swallowing evaluation
• Keep patient NPO (nothing by mouth) until safety is confirmed
• Suction the airway to remove visible secretions or aspirated material 3

2. Joint Aspiration (Arthrocentesis)

Removing fluid from a joint space, typically the knee, to diagnose infection (septic arthritis) or other joint problems. 2

When this is done: 2

• Suspected septic arthritis with joint swelling and pain
• To obtain synovial fluid for culture and cell count
• Synovial fluid white blood cell count ≥50,000 cells/mm³ suggests septic arthritis

Clinical approach: 2

• Joint aspiration is usually adequate for diagnosis when septic arthritis is suspected
• If joint aspirate is positive for infection, bone biopsy is typically not needed
• If aspirate is negative but suspicion remains high, percutaneous bone biopsy may follow

3. Abdominal/Cavity Aspiration

Removing fluid from the abdominal cavity, pleural space (around lungs), or other body cavities for diagnostic or therapeutic purposes. 4, 5

Diagnostic uses: 4, 5

• Determining if intra-abdominal infection or bleeding is present
• Analyzing fluid color, odor, and cell content
• Guiding decision for surgical intervention

Therapeutic uses: 6, 7

• Draining large symptomatic liver cysts (aspiration-sclerotherapy)
• Removing infected fluid collections or abscesses
• Simple abdominal abscesses can be cured with percutaneous drainage in 96% of cases 5

4. Pneumothorax Aspiration

Removing air from the pleural space when a lung has collapsed. 2

Procedure details: 2

• Performed in second intercostal space, mid-clavicular line
• Uses 16-gauge or larger cannula
• Aspirate up to 2.5 liters of air
• Successful if pneumothorax resolves or becomes small on repeat chest x-ray

Critical Management Points

If aspiration of food/liquid into lungs is suspected: 1, 3, 8

• Stop oral feeding immediately
• Maintain airway patency with supplemental oxygen if needed
• Assess level of consciousness—patients with reduced consciousness should remain NPO
• Order chest radiograph to look for aspiration pneumonia (lower lobe infiltrates, patchy opacities)
• Start broad-spectrum antibiotics covering oral flora and anaerobes if pneumonia develops
• Refer to speech-language pathologist before resuming any oral intake

Common pitfall: 3 Do NOT attempt abdominal thrusts or Heimlich maneuver to clear aspirated water from the lungs—this is unnecessary and potentially dangerous, as only modest amounts are typically aspirated and rapidly absorbed. 3

What to Ask Your Provider

To clarify what type of aspiration is being discussed, ask:

• "Are you concerned about food or liquid going into the lungs?"
• "Do you need to remove fluid from a joint or body cavity?"
• "Is this about draining an infection or collapsed lung?"

The answer will determine whether you're facing a swallowing safety issue requiring dietary modifications and therapy 2, 1, a diagnostic/therapeutic procedure to remove fluid 2, 4, or management of a pneumothorax. 2