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. .

During the procedure. it's sent for testing. After the fluid is removed from the chest. However. the doctor will insert a thin needle or plastic tube into the pleural space and draws out the excess fluid. This helps the lungs expand and take in more air. if there's a lot of fluid. Once the cause of the pleural effusion is known. Thoracentesis usually takes 10 to 15 minutes. It may take longer if there's a lot of fluid in the pleural . which allows breathing easier. the patient will be treated for that condition. It also may be done to help the patient breathe easier.♥Overview Thoracentesis is done to find the cause of a pleural effusion. the patient may be given antibiotics to fight the infection. they may take more. Usually. For example. if an infection is causing the excess fluid. the doctor will plan treatment. If the cause is heart failure. doctors take only the amount of fluid needed to find the cause of the pleural effusion.

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The scarring from the first procedure may make it difficult to do this procedure. your doctor will talk to you about the procedure and how to prepare for it. and about allergies to medicines or latex.Had lung surgery.A long-term (chronic). . • Before thoracentesis. about any previous bleeding problems. Tell your doctor what medicines you're taking.♥What To Expect Before Thoracentesis • You will be asked to sign a consent form before a thoracentesis. • Also. irreversible lung disease. certain conditions may increase the difficulty of thoracentesis. . such as emphysema. Let your doctor know if you have: .

♥Procedure♥ .

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.♥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.

if you are not certified). Anesthetize the skin and pleura. try to reach the effusion fluid.♥Perform the procedure (under supervision. .

♥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.

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such as driving.♥What To Expect After Thoracentesis • After thoracentesis. • Once at home. call your doctor right . physical activity. 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. and working.

The nature of the patient to the procedure. Pressure sensations to be experienced d.posteroanterior and lateral chest x-ray films are used to localize fluid and air in the pleural cavity and to aid in determining puncture site. 2. That no discomfort is anticipated after the procedure. 3. Assess the patient for allergy anesthetic agent to be used. assists the procedure patient to mobilize resources. Ascertain in advance whether chest xray films have been prescribed and completed and the consent form has been signed. Inform the patient about the -An explanation helps to orient the procedure: a. . The importance of remaining provides an opportunity to ask immobile c. . Give sedation if prescribed.♥Nursing activities RATIONALE 1. and b.

Straddling a chair with arms and head resting on the back of the chair.Lying on the unaffected side with the with the bed elevated 30 to 45 degrees if unable to assume a sitting position. Expose the entire chest. Make the patient comfortable with adequate supports. intercostals space in the midclavicular line because air rises in the thorax.Sitting on the edge of the bed with feet supported and arms and head on a padded over-the-bed table. Encourage the patient to refrain from coughing. . 5. The site for -If air is in the pleural cavity. A position of comfort helps the patient to relax. place the patient upright and is one of the following positions: a. 6.4. c. Prepare the patient for cold sensation of skin germicide solution and of pressure sensation from infiltration of local anesthetic agent. the thoracentesis aspiration is determined from chest x-ray films site is usually in the second or third and by percussion. If possible. b. a. Support and reassure the patient during the procedure. -The upright position facilitates the removal of fluid that usually localizes at the base of the chest. -Sudden and unexpected movement by the patient can cause trauma to the visceral pleura and lung. b.

The physician advances the thoracentesis needle with the syringe attached. After the skin is cleansed. 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. -An intradermal wheat is raised slowly. After the needle is withdrawn. a local anesthetic is injected slowly with a smallcaliber needle into the intercostals space by the physician. The procedure is performed under aseptic conditions. rapid injection causes pain. 8. the needle is held in place on the chest wall with a small hemostat 9. When the pleural space is reached. Sudden pleurific chest pain or shoulder pain may indicate that the visceral or diaphragmatic pleura is being irritated by the needle point.7. sterile dressing is fixed in place. -The hemostat steadies the needle on the chest wall. If a considerable quantity of fluid is removed. . pressure is applied over the puncture site and a small. a. The parietal pleura is very sensitive and should be well infiltrated with anesthetic before the thoracentesis needle is passed through it. suction maybe applied with the syringe. a three-way adapter serves to keep air from entering the pleural cavity. -when a large quantity of fluid is withdrawn.

uncontrollable cough. serous. prepare samples of fluid for laboratory evaluation. color. its purulent. A specimen container with formalin may be needed if a pleural biopsy is to be obtained. asymmetry in respiratory movement. 12. . tightness in chest. If requested. and its viscosity. and signs of hypoxemia -Pneumothorax. frothy mucus. Pulmonary edema or cardiac distress can be produced by a sudden shift in mediastinal contents when large amounts of fluid are aspirated. or pyrogenic infection may result from a thoracentesis. faintness. blood-tinged.10.A chest x-ray verifies that there is pneumothorax. vertigo. withdrawn and the nature of the fluid. a rapid pulse. Evaluate the patient at intervals for increasing respiratory rate. etc. bloody. 11. Record the total amount of fluid -The fluid may be clear. subcutaneous emphysema. tension pneumothorax. The patient is placed on bed rest. Chest x-ray is obtained after thoracentesis. .

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