Thoracentesis is a procedure to remove fluid from the pleural space by inserting a needle between the ribs and into the pleural cavity. It is done both diagnostically to evaluate pleural effusions and therapeutically to drain large fluid collections. The document outlines the indications, contraindications, necessary equipment and supplies, step-by-step procedure, monitoring after the procedure, potential risks and complications, and documentation required.
4. 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’’
6. Coagulation disorder
Active skin infection
Atelectasis
Only one functioning lung
Emphysema
Severe cough or hiccups
7. 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
8. 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.
16. Place patient upright position
R: 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
21. 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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24. 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.
25. Observe patient level of consciousness and give
emotional support
R: To reduce patient anxiety
Monitor saturation
R: To prevent hypoxia
Drain max 1.5 L in one sitting
R: avoid re-expansion pulmonary edema
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26. 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 fluid
R : To prevent over intake of the fluid to the
specimen bottle.
correct labelling of specimen bottle then send to
the lab
R: To prevent incorrect results to the patient.
27. 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.
28. Rest in bed for about 2 hours after the
procedure
R: To minimize patient activity due to
complication such as dyspnea.
Blood pressure and breathing will be checked for
up to a few hours
R: to make sure don't have complications
32. A therapeutic and diagnostic procedure in
which fluid is removed from the pericardial
space..
33. Cardiac Tamponade:
It is an abnormal accumulation of fluid in the
pericardial space, resulting in reduced ventricular
filling and subsequent hemodynamic compromise
34. Echocardiogram or ultrasound to identify
Fluid quantity
Coagulation
Loculation
Discontinue anticoagulants
Informed consent
full facilities for resuscitation
35. 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
36. Dilators (up to 7 French)
Pigtail catheter (60 cm with multiple side holes)
Drainage bag and connectors
Facilities for fluoroscopy or echocardiography
37. 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
38. Identify the anatomic landmark
Xiphoid process
5th
& 6th
ribs
Select a site for needle insertion
Most commonly used sites
Left sternocostal margin
Subxiphoid approach..
Procedure
39. Infiltrate the skin and subcutaneous tissues with local
anesthetic
Starting 1–1.5 cm below the xiphoid and left of midline
Staying 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 lidocaine
Aiming for the left shoulder
40. Aspirate during insertion
stop advancing the needle Once fluid is encountered
continue aspirating
Reassess for improvement
repeated if necessary
Procedure
41. 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 pressure
pulse
neck veins
The fluid should be tested for identification of
the cause.