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Thoracentesis is a procedure to remove fluid or air from around the lungs. A needle is put through the chest wall into the pleural space. The pleural space is the thin gap between the pleura of the lung and of the inner chest wall. The pleura is a double layer of membranes that surrounds the lungs. Inside the space is a small amount of fluid. The fluid prevents the pleura from rubbing together when you breathe. Excess fluid in the pleural space is called pleural effusion. When this happens, it’s harder to breathe because the lungs can’t inflate fully. This can cause shortness of breath and pain. These symptoms may be worse with physical activity. Why might I need thoracentesis?Thoracentesis may be done to find the cause of pleural effusion. It can also be done to treat symptoms of pleural effusion by removing fluid. The fluid is then examined in a lab. Thoracentesis can help diagnose health problems such as:
Your healthcare provider may have other reasons to advise thoracentesis. What are the risks of thoracentesis?All procedures have some risks. The risks of this procedure may include:
Your risks may vary depending on your general health and other factors. Ask your healthcare provider which risks apply most to you. Talk about any concerns you have. Thoracentesis should not be done in people with certain bleeding conditions. How do I get ready for thoracentesis?Your healthcare provider will explain the procedure to you. Ask any questions you have. You may be asked to sign a consent form that gives permission to do the procedure. Read the form carefully. Ask questions if anything is not clear. Tell your healthcare provider if you:
Make sure to:
You may have imaging tests before the procedure. These are done to find the location of the fluid to be removed. You may have any of the below:
What happens during thoracentesis?You may have your procedure as an outpatient. This means you go home the same day. Or it may be done as part of a longer stay in the hospital. The way the procedure is done may vary. It depends on your condition and your healthcare provider's methods. In most cases, a thoracentesis will follow this process:
What happens after thoracentesis?After the procedure, your blood pressure, pulse, and breathing will be watched. The dressing over the puncture site will be checked for bleeding or other fluid. If you had an outpatient procedure, you will go home when your healthcare provider says it’s OK. Someone will need to drive you home. At home, you can go back to your normal diet and activities if instructed by your healthcare provider. You may need to not do strenuous physical activity for a few days. Call your healthcare provider if you have any of the below:
Your healthcare provider may give you other instructions after the procedure. Next stepsBefore you agree to the test or the procedure make sure you know:
Thoracentesis, also known as pleural fluid analysis, is a procedure in which a needle is inserted through the back of the chest wall into the pleural space (a space that exists between the two lungs and the anterior chest wall) to remove fluid or air. Pleural fluid analysis is the microscopic and chemical lab analysis of the fluid obtained during thoracentesis. Thoracentesis may be performed for diagnostic and/or therapeutic reasons. The diagnostic use of a thoracentesis involves pleural fluid analysis to distinguish between exudate, which may result from inflammatory or malignant conditions, and transudate, which may result from failure of organ systems that affect fluid balance in the body. This analysis aids in determining the cause of the abnormality. Procedure1. Position patient in the sitting position with arms and head resting supported on a bedside adjustable table. 2. The usual site for insertion of the thoracentesis needle is the posterolateral aspect of the back over the diaphragm, but under the fluid level. 3. Select the thoracentesis site in an interspace below the point of dullness to percussion in the mid posterior line (posterior insertion) or mid axillary line (lateral insertion). 4. Sterile technique should be used including gloves, betadine prep and drapes. 5. Anesthetize the skin over the insertion site with 1% lidocaine using the 5 cc syringe with 25 or 27-gauge needle. Next anesthetize the superior surface of the rib and the pleura. The needle is inserted over the top of rib (superior margin) to avoid the intercostals nerves and blood vessels that run on the underside of the rib (the intercostals nerve and the blood supply are located near the inferior margin). As the needle is inserted, aspirate back on the syringe to check for pleural fluid. Once fluid returns, note the depth of the needle and mark it with a hemostat. This gives an approximate depth for insertion of the angiocatheter or thoracentesis needle. Remove the anesthetizing needle. 6.Use a hemostat to measure the same depth on the thoracentesis needle or angiocath as the first needle. While exerting steady pressure on the patient’s back with the nondominant hand, use a hemostat to measure the 15- to 18- gauge thoracentesis needle to the same depth as the first needle. While exerting steady pressure on the patient’s back with the nondominant hand, insert the needle through the anesthetized area with the thoracentesis needle. Advance the needle until it encounters the superior aspect of the rib. Continue advancing the needle over the top of the rib and through the pleura, maintaining constant gentle suction on the syringe. Make sure you march over the top of the rib to avoid the neurovascular bundle that runs below the rib. 7.Attach the three way stopcock and tubing, and aspirate the amount needed. Turn the stopcock and evacuate the fluid through the tubing. 8.Remove the necessary amount of pleural fluid (usually 100 mL for diagnostic studies), but generally not remove more than 1500 mL of fluid at any one time because of increased risk of pleural edema or hypotension. A pneumothorax from needle laceration of the visceral pleura is more likely to occur if an effusion is completely drained. 9. When draining of fluid is completed, have the patient take a deep breath and hum, and gently remove the needle. This maneuver increases intrathoracic pressure and decreases the chance of pneumothorax. Cover the insertion site with a sterile occlusive dressing. Thoracentesis Nursing ConsiderationsBefore the Procedure
During the Procedure
After the Procedure
Possible Nursing Diagnoses:Here are some possible nursing diagnoses for a patient post-thoracentesis (you may also check on the nursing care plans for Pleural Effusion)References: |