18864419-Thoracentesis

8/8/2019 18864419-Thoracentesis

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Th o ra ce n t e s is

Sacro, Joy Marian Victoria M.


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Thoracentesis

is an invasive procedure to remove fluid or air from the pleural space fordiagnostic or therapeutic purposes.

It is done with a needle (and sometimes

a plastic catheter) inserted through thechest wall, generally afteradministration of local anesthesia .

The recommended location varies

depending upon the source. Somesources recommend the midaxillary line, in the sixth, seventh, or eighthintercostal space .
http://en.wikipedia.org/wiki/Pleural_effusionhttp://en.wikipedia.org/wiki/Pneumothoraxhttp://en.wikipedia.org/wiki/Pleural_cavityhttp://www.webmd.com/hw-popup/placement-of-a-thoracentesis-needlehttp://en.wikipedia.org/wiki/Local_anesthesiahttp://en.wikipedia.org/wiki/Midaxillary_linehttp://en.wikipedia.org/wiki/Intercostal_spacehttp://en.wikipedia.org/wiki/Intercostal_spacehttp://en.wikipedia.org/wiki/Midaxillary_linehttp://en.wikipedia.org/wiki/Local_anesthesiahttp://www.webmd.com/hw-popup/placement-of-a-thoracentesis-needlehttp://en.wikipedia.org/wiki/Pleural_cavityhttp://en.wikipedia.org/wiki/Pneumothoraxhttp://en.wikipedia.org/wiki/Pleural_effusion


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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 paincaused by a pleural effusion.


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Overview Thoracentesis is done to find the cause of a pleural

effusion. It also may be done to help the patient breatheeasier.

During the procedure, the doctor will insert a thinneedle or plastic tube into the pleural space and drawsout the excess fluid. Usually, doctors take only theamount of fluid needed to find the cause of the pleuraleffusion. However, if there's a lot of fluid, they may takemore. This helps the lungs expand and take in more air,which allows breathing easier.

After the fluid is removed from the chest, it's sentfor testing. Once the cause of the pleural effusion isknown, the doctor will plan treatment. For example, if an infection is causing the excess fluid, the patient maybe given antibiotics to fight the infection. If the cause isheart failure, the patient will be treated for thatcondition.

Thoracentesis usually takes 10 to 15 minutes. Itmay take longer if there's a lot of fluid in the pleural


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What To Expect BeforeThoracentesis

You will be asked to sign a consent formbefore a thoracentesis.

Before thoracentesis, your doctor will talk toyou about the procedure and how to prepare

for it. Tell your doctor what medicines you'retaking, about any previous bleeding problems,and about allergies to medicines or latex.

Also, certain conditions may increase thedifficulty of thoracentesis. Let your doctorknow if you have:

- Had lung surgery. The scarring from thefirst procedure may make it difficult to do thisprocedure.

- A long-term (chronic), irreversible lungdisease, such as emphysema .
http://www.webmd.com/hw-popup/emphysema-8115http://www.webmd.com/hw-popup/emphysema-8115


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Pro ce d u re


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Find the anatomical landmarksbefore you perform the thoracentesis.


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Clean the area with iodine


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Open the kit and make surethat you know which tube and

needle are used for


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Practice sliding the flexiblecatheter.


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Prepare for local anesthesia.


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Prepare the area.


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Perform the procedure (undersupervision, if you are not certified).

Anesthetize the skin and pleura, try toreach the effusion fluid.


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Prepare the flexible catheter.


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Pass the flexible catheter over thetap needle into the pleural space andbegin aspirating the fluid in thevacuum tubes.


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What To Expect AfterThoracentesis

After thoracentesis, you may need achest x ray to check for any lungproblems. Your blood pressure and

breathing will be checked for up to afew hours to make sure you don't havecomplications.

Your doctor will let you know when youcan return to your normal activities,such as driving, physical activity, andworking.

Once at home, call your doctor right


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Nursing activities

-An explanation helps to orient the patient to the procedure, assists the patient to mobilize resources, and

provides an opportunity to ask

3. Inform the patient about the procedure: a. The nature of the procedure

b. The importance of remainingimmobile

c. Pressure sensations to be experiencedd. That no discomfort is anticipated after

the procedure.

2. Assess the patient for allergyanesthetic agent to be used. Givesedation if prescribed.

- posteroanterior and lateral chest x-rayfilms are used to localize fluid and air in the pleural cavity and to aid indetermining puncture site.

1. Ascertain in advance whether chest x-ray films have been prescribed andcompleted and the consent form has

been signed.

RATIONALE


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-If air is in the pleural cavity, the thoracentesissite is usually in the second or thirdintercostals space in the midclavicular line

because air rises in the thorax.

6. Expose the entire chest. The site for aspiration is determined from chest x-ray filmsand by percussion.

-Sudden and unexpected movement by the patient can cause trauma to the visceral pleuraand lung.

5. Support and reassure the patient during the procedure.a. Prepare the patient for cold sensation of skin germicide solution and of pressuresensation from infiltration of local anestheticagent.

b. Encourage the patient to refrain fromcoughing.

-The upright position facilitates the removal of fluid that usually localizes at the base of thechest. A position of comfort helps the patientto relax.

4. Make the patient comfortable with adequatesupports. If possible, place the patient uprightand is one of the following positions:

a.Sitting on the edge of the bed with feet

supported and arms and head on a padded over-the-bed table. b.Straddling a chair with arms and headresting on the back of the chair.c.Lying on the unaffected side with thewith the bed elevated 30 to 45 degrees if unable to assume a sitting position.


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9. After the needle is withdrawn, pressure isapplied over the puncture site and a small,sterile dressing is fixed in place.

-when a large quantity of fluid is withdrawn, athree-way adapter serves to keep air fromentering the pleural cavity.-The hemostat steadies the needle on the chestwall. Sudden pleurific chest pain or shoulder

pain may indicate that the visceral or diaphragmatic pleura is being irritated by theneedle point.

8. The physician advances the thoracentesisneedle with the syringe attached. When the

pleural space is reached, suction maybe appliedwith the syringe.a. A 20-ml syringe with a three-way adapter (stopcock) is attached to the needle and theother to the tubing leading to a receptable thatreceives the fluid being aspirated)

b. If a considerable quantity of fluid isremoved, the needle is held in place on the

chest wall with a small hemostat

-An intradermal wheat is raised slowly, rapidinjection causes pain. The parietal pleura isvery sensitive and should be well infiltrated

with anesthetic before the thoracentesis needleis passed through it.

7. The procedure is performed under asepticconditions. After the skin is cleansed, a localanesthetic is injected slowly with a small-

caliber needle into the intercostals space bythe physician.


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18864419-Thoracentesis