THORACENTESIS AND DIALYSIS.

THORACENTHESIS OR
THORACOCENTHESIS OR PLURAL TAP.

– Thoracentesis is a surgical puncture of the chest

wall to aspirate fluid or air from the pleural cavity.
– Thoracentesis is done to remove excess fluid
known as pleural effusion, from the pleural space
to make breathing easier.
 REASONS/ PURPOSE OF THORACENTESIS.
– Thoracentesis is done to remove air or fluid from the pleural
space, thereby improving ventilatory function.
– To study the chemical, bacteriological and cellular composition
of the pleural fluid.
– To instill medication into the thoracic cavity.
– To determine the cause of pleural effusion.
TYPES OF THORACENTESIS

THERAPEUTIC THORACENTESIS: this type of

thoracentesis is done to relief the symptoms of
fluid build up.

DIAGNOSTIC THORACENTESIS: this type of

thoracentesis is done to test for the cause of fluid
build up.
 INDICATIONS OF THORACENTESIS.

– Thoracentesis is indicated for symptomatic treatment

of large pleural effusion or treatment of empyema.
– Thoracentesis is indicated when unexplained fluid
accumulates in the chest cavity outside the lung.
CONTRAINDICATIONS.

– Uncorrected bleeding diathesis.

– Chest wall cellulitis at the site of puncture.
– An uncooperative patient or a coagulant disorder that
cannot be corrected.
POSITION FOR THORACENTHESIS
REQUIREMENT.

1. Two plain sterile dissecting forceps

2. One inch sterile artery forceps
3. Sterile syringes and needle(5ml/ 20ml/50ml)
4. Aspiration needle size 16,18,20
5. Sterile gauze pads
STEPS

1. Explain procedure to patient and encourage him/her to ask questions.

2. Send trolley to bedside and provide privacy.
3. Check vital signs and record.
4. Put patient in an upright position on a chair or bed with head and arms
resting on a bed table or the back of a chair.
5. Wash hands, hold anesthetic agent for physician to redraw the required
amount.
6. Maintain patients position through out the procedure.
STEPS

7. Observe patients pulse, respiration and degree of pain during the procedure
and record.
8. Encourage patient to remain still and not to cough during the procedure. If the
cough cannot be suppressed he should give a signal.
9. Apply a firm dressing at the end of procedure.
10. Label specimen if any and ensure they are sent to the laboratory with a signed
request form.
11. Make patient comfortable.
12. Remove trolley, decontaminate and sterilize the equipment.
CARE OR PATIENT MANAGEMENT AFTER
THORACENTESIS.

– After the procedure, observe changes in the

clients cough, sputum, respiratory depth,
breath sounds And note complains of chest
pain.
COMPLICATIONS OF THORACENTESIS.

1. Air in the space between the lung covering

(pleural space) that causes the lung to collapse
(pneumothorax).
2. Bleeding.
3. Infection.
4. Liver or spleen injury.
DIALYSIS
– Dialysis or renal replacement is a process of
removing excess water, solutes and toxins from
the blood in people whose kidneys can no longer
perform its functions naturally.
TYPES OF DIALYSIS

– Hemodialysis is a process of purifying the blood of a person whose kidneys are

not working normally.
– Peritoneal dialysis is a type of dialysis which is uses the peritoneum in a
persons abdomen as the membrane through which fluid and dissolved
substances are exchanged with blood. It is used to remove excess fluid, to
correct electrolyte problems and to remove toxins with those with kidney
failure.
ADVANTAGES OF PERITONEAL DIALYSIS
OVER HEMODIALYSIS.

1. It needs minimal preparation of patients and apparatus.

2. It requires minimal space.
3. It is cheap and easy to maintain.
4. There is less hemorrhage and acute electrolyte imbalance( in hemodialysis,
cerebral edema and convulsion may occur due to slow rate of urea clearance
from brain is in comparism with rapid clearance from other tissue).
INDICATIONS OF DIALYSIS.

• Severe fluid overload.

• Refractory hypertension.
• Uncontrollable hyperkalemia.
• Nausea, vomiting, poor appetite, gastritis with hemorrhage.
• Lethargy, malaise, stupor, coma, delirium, tremor, seizures.
• pericarditis (risk of hemorrhage or)
CONTRAINDICATIONS.

• Advanced malignancy.
• Hypotention unresponsiveness to pressors.
• Terminal illness.
• Organic brain syndrome.
MANAGEMENT OF CYCLE.

• Patient sits up in semi recumbent position.

– One and half liter of fluid run in rapidly in 10 minutes.
– Inlet and outlet clamped for 10 minutes.
• Fluid drain off into container on the floor.
• Drainage takes 10 to 15 minutes.
• Fresh fluid is inserted and cycle may be repeated for 48 hours.
• Dialysis may be repeated as often as possible or necessary but new catheter
inserted at each time.
COMPLICATIONS OF DIALYSIS.

hypotension
– cramps
– nausea and vomiting
– chest pain
– itchiness
– chills
THANK YOU.