PROCEDURE ON THORACENTESIS

INTRODUCTION- Thoracentesis is a procedure that removes an abnormal accumulation of fluid or air from the chest through a
needle or tube.it takes 15min, but it can take longer if there’s a lot of fluid in the pleural space. About 18-20gauze needle is used.
DEFINITION-:

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

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 fluids.
 To equalize pressure on both sides of the thoracic cavity.

INDICATION-:

 Traumatic pneumothorax
 Hemopneumothorax
 Spontaneous pneumothorax
 Bronchopleural fistula
 Pleural effusion

CONTRAINDICATION-:

 An uncooperative patient
 Coagulation disorder
 Atelectasis
 Only one functioning lungs
 Emphysema
 Severe cough or hiccups
COMPLICATION-:

 Pulmonary edema
 Respiratory distress
 Air embolism
 Cardiac tamponed
 Bleeding
 Infection
 Dyspnea and cough
 Atelectasis

PREPARE EQUIPMENT-:

EQUIPMENT RATIONAL
Dressing set To carry the sterile equipment
Abraham’s needle To aspirate the fluid .
Connecting tubing To provide the connection between the tubes
Syringe 50ml and 5ml To collect the fluid
Scapel blade To make a incision
Needles (18 and 23 gauge) To aspirate the fluid
Sterile gloves To prevent the cross infection
Mask To prevent the cross infection
Povidone / alcohol To clean the area
Local anaesthetic e.g-lignocaine To num the area
Formalin bottle To collect the sample
Urine bottle x 2 To collect the sample
C+S bottle To collect the sample
3 way stopcock To prevent the infection
Fenestrated towel To cover the body parts except the surgical area
BEFORE PROCEDURE

 Explain the purpose, risk /benefits, and steps of the procedure and obtain consent from the patient or appropriate legal design.

Rational – an explanation helps orient the patient to the procedure assist in coping and provide an opportunity to ask question
and verbalize anxiety.

 Take medical history such as –

 trouble in breathing ,coughing and hiccups
 had heart disease.
 Smoked
 Travelled to places where may have been exposed to tuberculosis.

Rational -: to detect any abnormalities regarding the procedure.

 Check platelet count and /or presence of coagulopathy .if platelet count is <20,000 or there is known coagulopathy as to
whether platelets transfusion or other intervention is needed.

Rational -: To prevent complication such as bleeding while during procedure.

 Place patient upright / cardiac position and help patient maintain position during procedure.

Rational –the upright position ensures that the diaphragm is more dependent and facilitates the removal of fluid that usually
localized at the base of the chest.

 Explain that he/she will receive a local anesthetic.

Rational -:to minimize pain during the procedure.

 Clean patient skin with antiseptic soap.

Rational-: to prevent infection and maintain aseptic technique.

DURING PROCEDURE

 Observe patient respiration rate and breathing pattern .

Rational-: to provide base line data to estimate patient tolerance of procedure.

 Assess patient vital sign such as BP/, pulse.

Rational-: to prevent any complication such as hypovolemic shock during procedure.

 Observe patient level of consciousness and give emotional support.

Rational -: to reduce patient anxiety

 Monitor saturation.

Rational-:to prevent hypoxia

 Inform doctor if any change of the patient .

Rational -:to make sure whether need to continue the procedure or stop immediately.
 AFTER PROCEDURE

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

Rational-:to compare the conditions of the lungs before and after the procedure.
 For specimen handling fill the tubes with the required amount of pleural fluid.

Rational-: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 records
numbers then send to the lab tests.
Rational -: To prevent from incorrect results to the patient.

 Document the procedure, patient’s response, characteristics of fluid and amount, and patient response to follow-up.

Rational-: To develop further treatment to the patient .

 Provide post-procedural analgesics as needed.

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

 Rest in bed for about 2hours after the procedure.

Rational-: To minimize patient activity due to complication such as dyspnea.

 Blood pressure and breathing will be checked for up to a few hours.

Rational -: To make sure don’t have complications.

 May remove dressing / bandage another day, or replace it if it become soiled or wet .
Rational-: To prevent from getting infection.

 Resume patient regular diet.

Rational-:to promote wound healing .

NURSING DIAGNOSIS

 Ineffective breathing pattern related to decreased lung volume capacity.

 Impaired gases exchange related to alveolar capillary membrane change.
 Impaired skin integrity related to Mechanical Factors Secondary to Thoracentesis and CTT Insertion.
 Acute pain related to surgical incision, chest tube sites, and immobility.
 Impaired physical mobility related to surgical procedure.

NURSING RESPONSIBILITY

 Wash hands thoroughly before and after the procedure.

 Explain the procedure to the client.
 Use the aseptic technique throughout the procedure.
 Identify the right client.
 Check the working condition of the equipment.
 Follow each and every step of procedure with rational.
 After procedure replace all the articles.
 Provide the fowler position to improve the breathing pattern
 Maintain the saturation level by providing oxygen.
 Provide the analgesics to reduce the pain.