THORACENTESIS

(Pleural Tap, Pleural Fluid Analysis)

BY:MS. SOFIA IRENE M. BRIONES, RN, MAN

What is thoracentesis and pleural fluid analysis?

• Thoracentesis 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 interior
chest wall) to remove fluid or air.
• Pleural fluid analysis is the microscopic and chemical lab analysis of the fluid obtained
during thoracentesis.
Anatomy of the respiratory system
The respiratory system is made up of the organs involved in the interchanges of gases, and
consists of the:
– nose
– pharynx
– larynx
– trachea
– bronchi
– Lungs
The upper respiratory tract includes the:
– nose
– nasal cavity
– ethmoidal air cells
– frontal sinuses
– maxillary sinus
– larynx
– trachea
The lower respiratory tract includes the lungs, bronchi, and alveoli.

Reasons for the Procedure

• 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.
• The therapeutic use of thoracentesis may be helpful in relieving symptoms such as
shortness of breath and pain.
The diagnostic findings are classified into two categories, exudate and transudate, and include,
but are not limited to, the following:
– infections (viral, fungal, or bacterial)
– cancer
– systemic lupus erythematosus - autoimmune disease in which the body attacks its
own tissues and can affect every organ system in the body
– pancreatitis - inflammation of the pancreas
– pulmonary embolism - a clot in the lung that causes lung tissue necrosis (death of
lung tissue)
– empyema - a collection of pus in the pleural space

Risks of the Procedure

As with any surgical procedure, complications can occur. Some possible complications may
include, but are not limited to, the following:
– pneumothorax - air becomes trapped in the pleural space causing the lung to
collapse
– pulmonary edema - fluid in the lungs
– bleeding
– infection
– Thoracentesis is contraindicated in certain bleeding conditions.
 – Patients who are allergic to or sensitive to medications, contrast dyes, iodine, shellfish, or
latex should notify their physician.
– If you are pregnant or suspect that you may be pregnant, you should notify your physician.
– There may be other risks depending upon your specific medical condition. Be sure to
discuss any concerns with your physician prior to the procedure.

Before the Procedure

 The physician will explain the procedure.
 You will be asked to sign a consent form.
 Generally, no prior preparation, such as fasting is required.
 If you are pregnant or suspect that you may be pregnant, you should notify your physician.
 Notify your physician if you are sensitive to or are allergic to any medications, latex,
iodine, tape, or anesthetic agents.
 Notify your physician of all medications and herbal supplements that you are taking.
 Notify your physician if you have a history of bleeding disorders or if you are taking any
anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood
clotting.
 You may have a diagnostic procedure.
 You may receive a sedative prior to the procedure to help you relax.
 The area around the puncture site may be shaved.
 Based upon your medical condition, your physician may request other specific preparation.
During the Procedure
Generally, a thoracentesis follows this process:
 You will be asked to remove any clothing, jewelry, or other objects that may
interfere with the procedure.
 If you are asked to remove clothing, you will be given a gown to wear.
 Your vital signs may be monitored before and during the procedure.
 You may receive supplemental oxygen as needed, through a face mask or nasal
cannula (tube).
 You will be placed in a sitting position with your arms raised and resting on an
overbed table. If you are unable to sit, you may be placed in a side-lying position on
the edge of the bed on your unaffected side.
 You may be asked not to cough, breathe in deeply, or move during the procedure.
 The skin at the puncture site will be cleansed with an antiseptic solution.
 You will receive a local anesthetic at the site where the thoracentesis is to be performed.
 When the area is numb, the physician will insert a needle between the ribs in your back.
 Once the physician has entered the pleural space with the needle, fluid will slowly be
withdrawn.
 If a pleural fluid analysis is to be done, several lab tubes will be filled with fluid and sent to
the lab.
 If there is a large amount of pleural fluid, the physician may attach tubing to the needle to
allow the fluid to drain into a bottle or other type of drainage system.
 When the fluid has been removed, the needle will be removed.
 A sterile bandage/dressing will be applied.
After the Procedure
• After the procedure, the client will be monitored until the blood pressure, pulse, and
breathing are stable.
• If the procedure was done at the bedside, the client will remain in the hospital room.
• If the procedure was performed on an outpatient basis, the client will be discharged,
unless the physician decides otherwise.
• The dressing over the puncture site will be monitored for bleeding or other drainage.
• The client will be positioned in a side-lying position with the unaffected side down for an
hour or longer.
• Chest x-ray maybe performed after the procedure.
• When the recovery period is over, the client may resume usual diet and activities unless
the physician advises differently.
• Notify physician to report any of the following:
• fever and/or chills
• redness, swelling, or bleeding or other drainage from the puncture site
• difficulty breathing
• The physician may give additional or alternate instructions after the procedure, depending
on the client’s particular situation.