THORACENTESIS

• It is the insertion of a needle to remove air

or excess fluid from the pleural space to ease
breathing or obtain pleural fluid sample for
diagnostic testing.
Purpose
Therapeutic
-To withdraw accumulated pleural fluid that causes pain
or dyspnea.

Diagnostic
-To obtain a sterile specimen for culture to determine the
infectious agent.
Positioning
• Best done with the patient sitting upright and
leaning slightly forward with arms supported.

• Recumbent or supine thoracentesis is possible

but best done using ultrasonography or CT to
guide procedure.
Sterile thoracentesis pack
• Gauze sponges
• Drape
• Fenestrated sheet
• Specimen container
• Sterile blade with holder
Outside the pack
• Trocar or cannula gauge 14 or 16 or needle gauge 14-17, 5-7 cm long (2-3 inches)
• IV tubing or venoset* may be omitted if the physician prefers to use disposable
pleural puncture set
• 3 way stopcock
• 30-50 cc
• Collection bag
• Plaster
• Sterile cotton balls and with antiseptic solution
• Picking working forceps
• Clean goes, mask and goggles
• Marker
• Kidney basin
• Scissors
• Pain medication
Assessment
1. Check physician’s order
2. Check informed consent
3. Determine the purpose of the procedure
4. Obtain vital signs and O2 saturation
5. Check underlying medical conditions
6. Assess respiratory functions
7. Assess for allergies
8. Det. The need of pre-procedure pain medication
9. Patient’s ability to assume the position required for the
procedure
Nursing DX
• Anxiety
• Fear
• Ineffective breathing pattern
• Risk for infection
• Risk for injury
Planning
• Patient’s ability to tolerate the procedure well
• Improvement of the respiratory status
• Ability to say the purpose of the procedure
Implementation
• PREPARATION

• Identify patient
• Explain procedure and provide privacy
• Wash hands
• Prepare the equipments needed
- Assemble all articles
- Check the expiration date
- Open sterile pack and makab-ot ras doctor
• X-ray available
• Prep. the patient
• Ihi daan
• Administer pre procedure meds
• Straight chair for doctor
Performance
• Assist the doctor
• Provide clean gown and mask
• Provide the needed supplies
• Covered the area with sterile dressing
• Offer anesthetic drug
• Apply pressure

• Assist the patient to maintain the correct position

• Monitor the patient for bradycardia or diaphoresis
End of procedure

• Position in a comfort bed

• Disposed used articles
• Remove the gloves
• Wash hands
• Label the specimen
• Let next nurse know about articles to nursing aid for
autoclaving
 Evaluation
• Note the amount of characteristics of the pleural fluid
• Monitor vital signs
• Monitor patient for possible complications
• Follow up
• Record the:
• Name of procedure
• Name of patient
• Punctured site location
• Amount of characteristics
• Duration of the procedure
• Tolerance
• VS
• Pain
• Complications
• Report to physician:
• Abnormal changes

• Document the x-ray

• Endorse to the next nurse appropriately
Unexpected outcomes
• The patient cannot follow the position properly
• Reassess and assist the client in proper positioning

• The patient moves abruptly or cough during procedure

• Remind the patient on the importance of remaining
immobile
• Notify the physician when the client wants to cough