THORACENTESIS
DEFINITION
It refers to the insertion of a needle into the pleural space to remove
accumulated fluid and air using aseptic technique.
PURPOSES
1. To remove air and fluid from pleural 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.
ARTICLES
1. A pleural aspiration set containing the following:
a. Sponge holding forceps (1 No.)
b.syringe (5 mL) and needle
c. Syringe (20 mL) with Luer-lock
d. Aspiration needles (No. 16 g)
e. Small bowls (2 Nos.)
f. Dissecting forceps (1 No.)
g. Artery forceps (1 No.)
h. Specimen bottles and slides
i. Gown, mask, and gloves Sterile dressing towels
j. Cotton swabs, gauze pieces, and pads
k. Scalpel blade.
2. A clean tray containing the following:
a. Mackintosh and towel
b. Kidney tray and paper bag
c. Spirit, povidone iodine
d. Lignocaine 2%
e. Adhesive plaster and scissors
f. Tincture benzoin.
3. Other articles like:
a. Cardiac table
b. Pillows.
PROCEDURE
Nursing action
Before procedure
1. Identify patient and explain the procedure to him and relatives. Explain
that during procedure he may experience a sensation of deep pressure
when fluid is aspirated.
2. Review the chest X-ray.
3. Obtain an informed consent from the patient.
4. Instruct patient that he should not move during the procedure.
5. Position the patient in any one position comfortably.
a. Sitting on the edge of bed with the feet supported, arms and head on
pillows over the cardiac table, or
b. Straddling a chair with arms and head resting on the back of the chair,
or
c. Lying on the unaffected side, with the bed elevated 30-40° if patient is
unable to assume sitting position.
During procedure
6. Expose the chest. The physician determines the site for aspiration by
visualizing chest X-ray and performing chest percussion. If air is to be
removed, the site is usually in 2nd and 3rd intercostal space. if fluid is to
be aspirated, then site is usually in the 8th and 9th intercostal space.
7. Clean the site with antiseptic solution and assist the physician in
administering local anesthesia.
8. The physician introduces the thoracentesis needle, Instruct the patient
to hold his breath when needle is inserted.
9. When needle is in pleural space, physician aspirates pleural fluid with
syringe. Assist in collecting specimen in sterile containers.
a. A 20 ml syringe with a three-way adapter is attached to needle. The
tubing which leads to the receptacle is attached to the third port of the
three-way adapter
b. If a considerable quantity of fluid is to be removed, the needle is held in
place on the chest wall.
10. a. For therapeutic purpose, usually 1,000-1,200 ml. of fluid is removed
and for diagnostic purpose, 30-60 mL of fluid is removed.
b. Encourage patient to remain still during the procedure and monitor vital
signs.
11. After the needle is withdrawn, apply tincture benzoin seal and
pressure dressing over the site.
12. Position patient in bed with affected side up. He should remain in bed
for 4-6 hours after the procedure.
13. Monitor vital signs every half an hour for 4-6 hours or till steady.
Observe patient for complications such as shock, fainting, low blood
pressure, rapid pulse, rapid respiration, uncontrolled cough, and blood
tinged frothy sputum. Check breath sounds in all lung fields.
After procedure
14. Record the procedure with total amount of fluid withdrawn, color,
nature, and signs of complications.
15. Send labeled specimen to laboratory.
16. Instruct patient to do deep breathing and coughing exercises.
Demonstrate and teach these exercises to patient.
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.
