THORACENTESIS

INTRODUCTION –
Thoracentesis is done with a needle (and sometimes a plastic
catheter) inserted through the chest wall to remove extra fluid from lungs. This
pleural fluid may be sent to a lab to determine what may be causing the fluid to
build up in the pleural space. Normally only a small amount of pleural fluid is
present in the pleural space. A buildup of excess pleural fluid (pleural effusion)
may be caused by many conditions, such as infection, inflammation, heart failure,
or cancer. If a large amount of fluid is present, it may be difficult to breathe. Fluid
inside the pleural space may be found during a physical examination and is usually
confirmed by a chest X-ray.

DEFINITION –
Thoracentesis is a procedure to remove fluid from the space
between the lungs and the chest wall called the pleural space.
(http://www.webmd.com//)

Thoracentesis is a procedure to remove excess fluid in the space between the lungs
and the chest wall. This space is called the pleural space. (http://www.nhlbi.com//)

Acc.To Annamma Jacob - Insertion of a needle into the pleural space to remove
accumulated fluid and air using aseptic techniques.

PURPOSES –
1. To remove air and fluid from plural cavity.
2. To decrease pressure on the lung tissue.
3. To aspirate pleural fluid for diagnostic studies.
4. To instill medication into the pleural space.
5. To perform pleural biopsy.

INDICATION
 Pleural effusion.
 Heart failure.
 lung cancer
  tumors
 pneumonia
 tuberculosis
 pulmonary embolism
 Other lung infections.
 Asbestosis
 sarcoidosis
 reactions to some drugs

DIAGNOSTIC STUDIES -
1. Medical History
Your doctor will ask about your symptoms, such as trouble breathing,
coughing, and hiccups. Other things your doctor may ask about include
whether you've ever:
o Had heart disease
o Smoked
o Traveled to places where you may have been exposed to tuberculosis
o Had a job that exposed you to asbestos

2. Physical Exam
Your doctor will listen to your breathing with a stethoscope and tap lightly
on your chest. If you have a pleural effusion, your breathing may sound
muffled. There also may be a dull sound when your doctor taps on your
chest.

3. Diagnostic Tests
Your doctor may use one or more of the following tests to diagnose a
pleural effusion.
 Chest x ray. -This test takes pictures of the structures inside your chest,
such as your heart and lungs. The test may show air or fluid in the pleural
space. It also may show the cause of the pleural effusion, such as
pneumonia or a lung tumor.
 Ultrasound.- This test uses sound waves to create pictures of the structures
in your body, such as your lungs. Ultrasound may show where fluid is in
 your chest. Sometimes the test is used to find the right place to insert the
needle or tube for thoracentesis.
 Chest computed tomography scan- . This test provides a computer-
generated picture of the lungs that can show pockets of fluid. It may show
fluid when a chest x ray doesn't. It also may show signs of pneumonia or a
tumor.

ARTICLES
A pleural aspiration set containing:
1. Sponge holding forecep (1)
2. Syringe (5ml) and needle.
3. Syringe (20 ml) with leurlock
4. Aspiration needle (no. 16 G)
5. Small bowls (2)
6. Dissecting forceps (1)
7. Artery forceps (1)
8. Specimen bottle and slides
9. Gown, mask, and gloves
10.Sterile dressing towels
11.Cotton swabs, gauze pieces and pads
12.Scalpel blade
Clean tray containing
1. Macintosh and towel
1. Kindey tray and paper bag
2. Spirit ,lodine
3. Lignocaine 2 %
4. Adhesive plaster and scissors
5. Tincture benzoin
Other articles like
1. Cardiac table
2. Pillows.

PREPARATION OF PATIENT -

 You will be asked to sign a consent form before a thoracentesis.

  Talk to your doctor about any concerns you have regarding the need for the
test, its risks, how it will be done, or what the results will mean. To help you
understand the importance of this procedure, fill out the medical test
information form.
 Tell your doctor if you:
 Have allergies to any medicines, including anesthetics.
 Have any bleeding problems or take blood thinners, such as aspirin or
warfarin (Coumadin).
 Are or might be pregnant.
 Also, certain conditions may increase the difficulty of thoracentesis. Let
your doctor know if you have:
 Had lung surgery. The scarring from the first procedure may make it
difficult to do this procedure.
 A long-term (chronic), irreversible lung disease, such as emphysema.
 A chest X-ray is usually done before the procedure.
 Your doctor may order certain blood tests, such as a complete blood count
(CBC) and bleeding factors, before your procedure.

PROCEDURE –

SN NURSING ACTION RATIONALE

O
1 Identify patient and explain procedure to him and Allays anxiety and
relatives. Explain that during procedure he may wins cooperation.
experience a sensation of deep pressure when fluid is
aspirated.
2 Review the chest x ray. X ray shows localized
of fluid and air in
pleural cavity for
determining puncture
site.
3 Obtain an informed consent from patient. Avoid risk of legal
complication.
4 Instruction patient that he should not to move, cough, Any movement
or breathe deeply during procedure coughing during
 procedure can cause
injury to vital organs
or blood vessel.
5 Position the patient comfortably. An upright position
Sitting on the edge of bed with feet supported, arms facilitates localization
and head on pillows over the cardiac table. of fluid at the base of
Straddling a chair with arms and head resting on the the chest.
back of the chair.
Lying on the unaffected side with the bed elevated
30- 40 degree if patient is unable to assume sitting
position.
6 Expose the chest. The physician determines the site Fluid usually localizes
for aspiration by visualizing chest x ray and at the base of the
performing chest percussion. If air is to be removed chest.
the site is usually in 2nd and 3rd intercostals space. If
fluid is to be aspirated then site is usually in the 8 th
and 9th intercostals’ space.

7 Clean the site with antiseptic solution and assisting Reduces risk of
the physician in administering local anesthesia. infection.

8 The physician introduces the Thoracentesis needle. Respiratory movement

Instruct the patient to hold his breath when needle is can cause risk of
inserted. puncture to vital
organ.
9 When needle is in pleural space, physician aspirates The three way adapter
pleural fluid with syringe. Assisting in collecting helps in preventing air
specimen in sterile containers. from entering the
A 20 ml syringe with a three –way adapter is pleural cavity when
attached to needle. The tubing which leads to the large volumes of fluid
receptacle is attached to the third port of the three- are removed.
way adapter
If a considerable quantity of the fluid is to be Hemostat steadies the
removed, the needle is held in place on the chest wall needle on the chest
with a small hemostat. wall sudden chest pain
or shoulder pain
 indicates that the
needle point is
irritating pleural
cavity.
10 For therapeutic purpose usually 1000- 2000 ml fluid
is removed and for diagnostic purpose 30 – 60 ml of
fluid is removed encourage patient to remain still
during the procedure and monitor vital signs
11 After needle is withdrawn, apply tincture benzoin Pressure dressing
seal and dressing over the site. prevents risk of
bleeding ,leakage and
infection at site.
12 Position patient in bed with affected side up. He This position
should remain in bed for 4-6 hours after procedure. minimize risks of
possible fluid leakage.
13 Monitor vital signs every half an hour for 4-6 hours Complication may
or till steady observe patient for complication such as occur because of
shock, fainting, low blood pressure, rapid pulse, accidental puncture of
rapid respiration, uncontrolled cough and blood vital organs or blood
tinged frothy sputum. Check breath sounds in all vessels.
lung fields.
14 Records the procedure with total amount of amount
of fluid withdrawn, colour, nature and signs of
complication.
15 Send labeled specimen to laboratory.
16 Instruct patient to do deep breathing and coughing Deep breathing and
exercises. Demonstration and teach these exercise to coughing promotes
patient. lung expansion.
17 Have a chest x ray if indicated.
18 Wash articles used for thoracentesis in cold water
and then in warm soapy water. Rinse, dry and send
for autoclaving. Wear gloves while washing.
AFTER THORACENTESIS PROCEDURE-
1. After thoracentesis, you may need a chest x ray to check for any lung
problems.

2. Your blood pressure and breathing will be checked for up to a few hours to
make sure you don't have complications.

3. Your doctor will let you know when you can return to your normal
activities, such as driving, physical activity, and working.

4. Once at home, call your doctor right away if you have any breathing
problems.

COMPLICATION –
1. Pneumothorax
2. Heamothorax
3. Tension Pneumothorax
 4. Mediastinal shift
5. Pulmonary oedema
REFERENCES –
1. Annamma Jacob “clinical nursing procedures: the art of nursing practice”
first edition, jaypee brothers medical publisher (p) ltd. page 397 – 398.
2. Sr. Nancy “principles and practice of nursing, senior nursing procedures”4 th
edition volume II, N.R Publishing house, page no 248- 262.
3. http://www.nhlbi.com//
4. http://www.webmd.com//