Thoracentesis

Sacro, Joy Marian Victoria M.

♥Thoracentesis

• is an invasive procedure to remove fluid

or air from the pleural space for
diagnostic or therapeutic purposes.
• It is done with a needle (and sometimes
a plastic catheter) inserted through the
chest wall, generally after
administration of local anesthesia.
• The recommended location varies
depending upon the source. Some
sources recommend the midaxillary line
, in the sixth, seventh, or eighth
intercostal space.
♥Why is it done?
• Removal of fluid and air from the
pleural cavity
• Diagnostic aspiration of pleural fluid
• Pleural biopsy
• Instillation of medication into the
pleural space
• Relieve shortness of breath and pain
caused by a pleural effusion.
♥Overview
Thoracentesis is done to find the cause of a pleural
effusion. It also may be done to help the patient breathe
easier.

During the procedure, the doctor will insert a thin

needle or plastic tube into the pleural space and draws
out the excess fluid. Usually, doctors take only the
amount of fluid needed to find the cause of the pleural
effusion. However, if there's a lot of fluid, they may take
more. This helps the lungs expand and take in more air,
which allows breathing easier.

After the fluid is removed from the chest, it's sent

for testing. Once the cause of the pleural effusion is
known, the doctor will plan treatment. For example, if
an infection is causing the excess fluid, the patient may
be given antibiotics to fight the infection. If the cause is
heart failure, the patient will be treated for that
condition.

Thoracentesis usually takes 10 to 15 minutes. It

may take longer if there's a lot of fluid in the pleural
♥What To Expect Before
Thoracentesis
• You will be asked to sign a consent form
before a thoracentesis.
• Before thoracentesis, your doctor will talk to
you about the procedure and how to prepare
for it. Tell your doctor what medicines you're
taking, about any previous bleeding problems,
and about allergies to medicines or latex.
• Also, certain conditions may increase the
difficulty of thoracentesis. Let your doctor
know if you have:
- Had lung surgery. The scarring from the
first procedure may make it difficult to do this
procedure.
- A long-term (chronic), irreversible lung
disease, such as emphysema.
♥Procedure♥
♥Find the anatomical landmarks
before you perform the thoracentesis.
♥Clean the area with iodine
♥Open the kit and make sure
that you know which tube and
needle are used for
♥Practice sliding the flexible
catheter.
♥Prepare for local anesthesia.
♥Prepare the area.
♥Perform the procedure (under
supervision, if you are not certified).
Anesthetize the skin and pleura, try to
reach the effusion fluid.
♥Prepare the flexible catheter.
♥Pass the flexible catheter over the
tap needle into the pleural space and
begin aspirating the fluid in the
vacuum tubes.
♥What To Expect After
Thoracentesis
• After thoracentesis, you may need a
chest x ray to check for any lung
problems. Your blood pressure and
breathing will be checked for up to a
few hours to make sure you don't have
complications.
• Your doctor will let you know when you
can return to your normal activities,
such as driving, physical activity, and
working.
• Once at home, call your doctor right
♥Nursing activities
RATIONALE

1. Ascertain in advance whether chest x- - posteroanterior and lateral chest x-ray

ray films have been prescribed and films are used to localize fluid and air
completed and the consent form has in the pleural cavity and to aid in
been signed. determining puncture site.
2. Assess the patient for allergy
anesthetic agent to be used. Give
sedation if prescribed.
3. Inform the patient about the -An explanation helps to orient the
procedure: a. The nature of the patient to the procedure, assists the
procedure patient to mobilize resources, and
b. The importance of remaining provides an opportunity to ask
immobile
c. Pressure sensations to be experienced
d. That no discomfort is anticipated after
the procedure.
4. Make the patient comfortable with adequate -The upright position facilitates the removal of
supports. If possible, place the patient upright fluid that usually localizes at the base of the
and is one of the following positions: chest. A position of comfort helps the patient
a.Sitting on the edge of the bed with feet to relax.
supported and arms and head on a
padded over-the-bed table.
b.Straddling a chair with arms and head
resting on the back of the chair.
c.Lying on the unaffected side with the
with the bed elevated 30 to 45 degrees if
unable to assume a sitting position.
5. Support and reassure the patient during the -Sudden and unexpected movement by the
procedure. patient can cause trauma to the visceral pleura
a. Prepare the patient for cold sensation of and lung.
skin germicide solution and of pressure
sensation from infiltration of local anesthetic
agent.
b. Encourage the patient to refrain from
coughing.
6. Expose the entire chest. The site for -If air is in the pleural cavity, the thoracentesis
aspiration is determined from chest x-ray films site is usually in the second or third
and by percussion. intercostals space in the midclavicular line
because air rises in the thorax.
7. The procedure is performed under aseptic
conditions. After the skin is cleansed, a local
anesthetic is injected slowly with a small-
caliber needle into the intercostals space by
the physician.
8. The physician advances the thoracentesis
needle with the syringe attached. When the
pleural space is reached, suction maybe applied
with the syringe.
a. A 20-ml syringe with a three-way adapter
(stopcock) is attached to the needle and the
other to the tubing leading to a receptable that
receives the fluid being aspirated)
b. If a considerable quantity of fluid is
removed, the needle is held in place on the
chest wall with a small hemostat
9. After the needle is withdrawn, pressure is
applied over the puncture site and a small,
sterile dressing is fixed in place.
-An intradermal wheat is raised slowly, rapid
injection causes pain. The parietal pleura is
very sensitive and should be well infiltrated
with anesthetic before the thoracentesis needle
is passed through it.
-when a large quantity of fluid is withdrawn, a
three-way adapter serves to keep air from
entering the pleural cavity.
-The hemostat steadies the needle on the chest
wall. Sudden pleurific chest pain or shoulder
pain may indicate that the visceral or
diaphragmatic pleura is being irritated by the
needle point.
10. The patient is placed on bed rest.
Chest x-ray is obtained after
thoracentesis.
11. Record the total amount of fluid
withdrawn and the nature of the fluid, its purulent, etc.
color, and its viscosity. If requested,
prepare samples of fluid for laboratory
evaluation. A specimen container with
formalin may be needed if a pleural
biopsy is to be obtained.
12. Evaluate the patient at intervals for
increasing respiratory rate; asymmetry in
respiratory movement; faintness;
vertigo; tightness in chest;
uncontrollable cough; blood-tinged,
frothy mucus; a rapid pulse, and signs of
hypoxemia
- A chest x-ray verifies that there is
pneumothorax.
-The fluid may be clear, serous, bloody,
-Pneumothorax, tension pneumothorax,
subcutaneous emphysema, or pyrogenic
infection may result from a
thoracentesis. Pulmonary edema or
cardiac distress can be produced by a
sudden shift in mediastinal contents
when large amounts of fluid are
aspirated.
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