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o Thoracentesis is a percutaneous procedure
during which a needle is inserted into the
pleural space and pleural fluid is removed
either through the needle or a catheter.
o ‘’Pleural tap’’ OR ‘’pleural fluid aspiration’’
Diagnostic• Pleural effusion
• Hemopneumothorax
• Empyema
Therapeutic• Large peural effusion
• Relieve the symptoms
Coagulation disorder
Active skin infection
Atelectasis
Only one functioning lung
Emphysema
Severe cough or hiccups
An uncooperative patient
Explain the purpose, risks/benefits, and steps of the procedure and obtain consent from the patient or appropriate legal design.
R: An explanation helps orient the patient to the procedure assist in coping and provide an opportunity to ask question and verbalise anxiety
Do Diagnostic Tests such as Chest X-ray Ultrasound
R: to determine the affected lung
Check platelet count and/or presence of coagulopathy
R: To prevent complication such as bleeding during procedure.
Dressing set
Abraham’s needle
Connecting tubing
Syringe
Needles (18 and 23 gauge)
Sterile Glove
Mask
Povidone / Alcohol
Local anaesthetic
Formalin bottle
Urine bottle x2
C+S bottle
3-way stopcock
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Place patient upright positionR: Ensures that the diaphragm is more dependent and facilitates the removal of fluid.
The lateral recumbent position if the patient is unable to sit upright.
BEFORE THE PROCEDURE
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Explain that he/she will receive a local anesthetic
R: to minimize pain during the procedure.
Clean patient skin with antiseptic
R: To prevent infection and maintain aseptic technique.
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Observe patient respiration rate and breathing pattern.
R: to provide base line data to estimate patient tolerance of procedure
Assess patient vital sign such as B/P, pulse
R: To prevent any complication such as hypovolemic shock during procedure.
Observe patient level of consciousness and give emotional support
R: To reduce patient anxiety
Monitor saturationR: To prevent hypoxia
Drain max 1.5 L in one sittingR: avoid re-expansion pulmonary edema
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Obtain a chest x-ray to evaluate the fluid level.R: To compare the conditions of the lungs before
and after the procedure. For specimen handling, fill the tubes with the
required amount of pleural fluidR : To prevent over intake of the fluid to the
specimen bottle. correct labelling of specimen bottle then send to
the labR: To prevent incorrect results to the patient.
Document the procedure, patient’s response, characteristics of fluid and amount, and patient response to follow-up.
R: To develop further treatment to the patient.
Provide post-procedural analgesics as needed. R: To prevent patient from pain related to the
incision site.
Rest in bed for about 2 hours after the procedureR: To minimize patient activity due to complication such as dyspnea.
Blood pressure and breathing will be checked for up to a few hoursR: to make sure don't have complications
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Pulmonary edema
Respiratory distress
Air embolism
Bleeding
Infection
Dyspnea and cough
Atelectasis
Pericardiocentesis
A therapeutic and diagnostic procedure in which fluid is removed from the pericardial space..
Cardiac Tamponade: It is an abnormal accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and subsequent hemodynamic compromise
Echocardiogram or ultrasound to identify Fluid quantity Coagulation Loculation
Discontinue anticoagulants
Informed consent
full facilities for resuscitation
Table for central line insertion with chlorhexidine for skin dressing pack sterile drapes local anesthetic (lidocaine 2%) syringes (including a 50 mL) needles (25G and 22G)
Pericardiocentesis needle (15 cm, 18G) Wallace cannula
Dilators (up to 7 French)
Pigtail catheter (60 cm with multiple side holes)
Drainage bag and connectors
Facilities for fluoroscopy or echocardiography
Position the patient at ~30°
Sedate lightly with midazolam
Wear sterile gown and gloves
clean the skin from mid-chest to mid-abdomen
sterile drapes on the patient
Identify the anatomic landmark Xiphoid process5th & 6th ribs
Select a site for needle insertion
Most commonly used sites Left sternocostal margin Subxiphoid approach..
Procedure
Infiltrate the skin and subcutaneous tissues with local anesthetic
Starting 1–1.5 cm below the xiphoid and left of midlineStaying close to the inferior border of the rib cartilages.
Insert the needle b/w xiphoid and left costal margin Angled at ~30°
Advance slowly, Aspirating & injecting lidocaineAiming for the left shoulder
Aspirate during insertion
stop advancing the needle Once fluid is encountered
continue aspirating
Reassess for improvement
repeated if necessary
Procedure
After the procedure Tube is left connected to drainage bottle
no more fluid drained no accumulation of fluid in the pericardium
Echocardiogram to monitor clearance of fluid.
Monitor blood pressurepulse neck veins
The fluid should be tested for identification of the cause.
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Risk and Complication Cardiac arrest
Myocardial infarction
Heart attack
Laceration of heart muscle
Arrythmias
Laceration of organs
Puncture of coronary arteries
Hemothorax
Pneumothorax
Pneumohemothorax