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DEFINITION

Thoracentesis is a procedure to remove fluid from the space between the lungs and the chest wall called the pleural space.

Thoracentesis is a procedure that removes an abnormal accumulation of fluid or air from the chest through a needle or tube.

PURPOSE To determine the cause of abnormal

accumulation of fluid in the pleural space.

Relieve shortness of breath and pain

As a diagnostic or treatment procedure

To drain large amounts of pleural fluid

To equalize pressure on both sides of the thoracic cavity

INDICATION

Traumatic pneumothoraxHemopneumothorax Spontaneous pneumothoraxBronchopleural fistula Pleural effusion

CONTRAINDICATIONAn uncooperative patient

Coagulation disorder

Atelectasis

Only one functioning lung

Emphysema(pulmonary enlargement)

Severe cough or hiccups

COMPLICATION Pulmonary edema

Respiratory distress

Air embolism

Cardiac tamponade(fluid build up in the space between myocardium and pericardium)

Bleeding

Infection

Dyspnea and cough

Atelectasis(lung collapes)

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BEFORE THE PROCEDURE Explain the purpose, risks/benefits,

and steps of the procedure and obtain consent from the patient or appropriate legal design.R: An explanation helps orient the patient to the procedure assist in coping and provide an opportunity to ask question and verbalise anxiety

CON’T…Take Medical History such asTrouble in breathing, coughing, and hiccupsHad heart disease Smoked Travelled to places where may have been

exposed to tuberculosis R: to detect any abnormalities regarding the procedure

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• Prepare Equipment Dressing setAbraham’s needleConnecting tubingSyringe 50ml and

5mlScapel blade and

blade 11Needles (18 and 23

gauge)Sterile GloveMask

Povidone / AlcoholLocal anaesthetic,

e.g. lignocaine (lidocaine) 1% or 2%

Formalin bottleUrine bottle x2C+S bottle3-way stopcockFenestrated towelJug

BEFORE THE PROCEDURE Check platelet count and/or

presence of coagulopathy. If platelet count is < 20,000, or there is known coagulopathy as to whether platelet transfusion or other intervention is needed 

R: To prevent complication such as bleeding while during procedure.

Place patient upright / cardiac position and help patient maintain position during procedure.R: the upright position ensures that the diaphragm is more dependent and facilitates the removal of fluid that usually localizes at the base of the chest.

Explain that he/she will receive a local anestheticR: to minimize pain during the procedure.

Clean patient skin with antiseptic soap R: To prevent infection and maintain aseptic technique.

DURING PROCEDUREObserve patient respiration rate and

breathing pattern.R: to provide base line data to estimate patient tolerance of procedure

Assess patient vital sign such as B/P, pulseR: To prevent any complication such as hypovolemic shock during procedure.

Observe patient level of consciousness and give emotional supportR: To reduce patient anxiety

DURING PROCEDUREMonitor saturation

R: To prevent hypoxia

Inform doctor if any changes of the patientR: To make sure whether need to continue the procedure or stop immediately.

AFTER PROCEDURE Obtain a chest x-ray to evaluate the fluid level.

R: To compare the conditions of the lungs before and after the procedure.

For specimen handling, fill the tubes with the required amount of pleural fluidR : To prevent over intake of the fluid to the specimen bottle.

Check that each bottle is correctly labelled by checking patient identifiers- full name, date of birth and/or medical record number then send to the lab testsR: To prevent from incorrect results to the patient.

AFTER PROCEDURE Document the procedure, patient’s response,

characteristics of fluid and amount, and patient response to follow-up.

R: To develop further treatment to the patient.

Provide post-procedural analgesics as needed.

R: To prevent patient from pain related to the incision site.

AFTER PROCEDURE

Rest in bed for about 2 hours after the procedureR: To minimize patient activity due to complication such as dyspnea.

Blood pressure and breathing will be checked for up to a few hoursR: to make sure don't have complications

AFTER PROCEDURE May remove dressing/bandage another day,

or replace it if it becomes soiled or wetR: To prevent from getting infection.

Resume patient regular diet.R: To promote wound healing.

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