Thoracentesis

Subject: Medical and Surgical Nursing I (Theory)

Overview

Thoracentesis is a procedure that removes pleural fluid from the area between the lung and the chest wall in order to obtain pleural fluid specimens for testing the origin and nature of pleural effusion.

Preparation

  • Examine the patient's medical history for any bleeding issues or anticoagulant therapy.
  • Explain that a chest x-ray or ultrasound scan may be performed prior to the test.
  • To reduce the danger of lung harm, instruct the patient not to cough, breathe heavily, or move during the test.
  • Take baseline vital signs for the patient.
  • If necessary, shave the area around the needle insertion site and properly position the patient.

Thoracentesis is a surgical treatment that removes pleural fluid from the area between the lung and the chest wall. The pleural space is the area where this fluid collects.

Purpose

  • To collect pleural fluid specimens in order to determine the cause and nature of pleural effusion.
  • To alleviate symptoms associated with a large pleural effusion.

Preparation

  • Examine the patient's medical history for any bleeding issues or anticoagulant medication.
  • Explain that the test may be preceded by a chest x-ray or an ultrasound.
  • To reduce the danger of lung harm, instruct the patient not to cough, breathe heavily, or move throughout the test.
  • Take baseline vital readings for the patient.
  • If required, shave the region around the needle insertion site and appropriately situate the patient.

Procedure

  • Position the patient to enlarge the intercostal gap and give easier access to the pleural cavity.
  • If the patient is unable to sit up, place him on his unaffected side, with the arm on his affected side elevated.
  • Prepare and drape the spot when the patient has been properly positioned.
  • Inject a topical anesthetic into the subcutaneous area before inserting the thoracentesis needle.
  • When the needle reaches the fluid pocket, it is linked to a 50ml syringe or a vacuum bottle, and the fluid is withdrawn.
  • During aspiration, the patient is monitored for signs of respiratory distress and hypotension.
  • Pleural fluid properties and total volume are recorded.
  • After the needle is removed, exert pressure until hemostasis is achieved and a tiny dressing is put.
  • Place specimens in correctly labeled containers and send to the laboratory as soon as possible.
  • Pleural fluid must be collected anaerobically, heparinized, preserved on ice, and evaluated as soon as possible.

Nursing Management

  • Elevate the head of the bed to facilities breathing.
  • Obtain x-ray chest
  • If breathing difficult immediately report to a doctor.
  • Monitor the patient for reexpansion pulmonary edema.
  • Monitor vital sign
  • Observed the puncture site and dressing
  • Watch for subcutaneous emphysema
  • Monitor pleural pressure.

Normal Result

  • Negative pressure in the pleural cavity with less than 50ml serous fluid.

Complication

  • Laceration
  • Pneumothorax
  • Mediastinal shift
  • Reexpansion pulmonary edema ‘
  • Bleeding and infection

References

  • emedicine.medscape.com/article/80640-overview

  • https://www.nhlbi.nih.gov/health/health-topics/topics/thor
  • Mandal, G. (August 2013). A Textbook of Adult Health Nursing (2nd ed.). Dilllibazar kathmandu: Makalu publication house. Retrieved August 2013
  • www.webmd.com/lung/thoracentesis

 
Things to remember
  • Negative pleural pressure with less than 50ml serous fluid.
  • Elevate the head of the bed to make breathing easier.
  • The pleural space is the area where this fluid collects.

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