Thoracentesis

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2. DEFINITION
Thoracentesis is a procedure to remove fluid
from the space between the lungs and the
chest wall called the pleural space.
Thoracentesis is a procedure that removes an
abnormal accumulation of fluid or air from the
chest through a needle or tube.

3. PURPOSE
To determine the cause of abnormal
accumulation of fluid in the pleural space.
Relieve shortness of breath and pain
As a diagnostic or treatment procedure
To drain large amounts of pleural fluid
To equalize pressure on both sides of the
thoracic cavity

4. INDICATION
Traumatic pneumothorax
Hemopneumothorax
Spontaneous pneumothorax
Bronchopleural fistula
Pleural effusion

5. CONTRAINDICATION
An uncooperative patient
Coagulation disorder
Atelectasis
Only one functioning lung
Emphysema(pulmonary enlargement)
Severe cough or hiccups

6. COMPLICATION
Pulmonary edema
Respiratory distress
Air embolism
Cardiac tamponade(fluid
build up in the space
between myocardium and
pericardium)
Bleeding
Infection
Dyspnea and
cough
Atelectasis(lung
collapes)

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8. BEFORE THE PROCEDURE
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

9. CON’T…
Take Medical History such as
Trouble in breathing, coughing, and hiccups
Had heart disease
Smoked
Travelled to places where may have been exposed to
tuberculosis
R: to detect any abnormalities regarding the
procedure
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10. • Prepare Equipment
Dressing set
Abraham’s needle
Connecting tubing
Syringe 50ml and 5ml
Scapel blade and blade 11
Needles (18 and 23
gauge)
Sterile Glove
Mask
Povidone / Alcohol
Local anaesthetic, e.g.
lignocaine (lidocaine) 1%
or 2%
Formalin bottle
Urine bottle x2
C+S bottle
3-way stopcock
Fenestrated towel
Jug

11. BEFORE THE PROCEDURE
Check platelet count and/or presence of
coagulopathy. If platelet count is < 20,000,
or there is known coagulopathy as to
whether platelet transfusion or other
intervention is needed
R: To prevent complication such as bleeding
while during procedure.

12. Place patient upright / cardiac position and
help patient maintain position during procedure.
R: the upright position ensures that the
diaphragm is more dependent and facilitates the
removal of fluid that usually localizes at the base
of the chest.
Explain that he/she will receive a local
anesthetic
R: to minimize pain during the procedure.
Clean patient skin with antiseptic soap
R: To prevent infection and maintain aseptic
technique.

14. DURING PROCEDURE
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

15. DURING PROCEDURE
Monitor saturation
R: To prevent hypoxia
Inform doctor if any changes of the patient
R: To make sure whether need to continue the
procedure or stop immediately.

16. AFTER PROCEDURE
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.
Check that each bottle is correctly labelled by
checking patient identifiers- full name, date of birth
and/or medical record number then send to the lab
tests
R: To prevent from incorrect results to the patient.

17. AFTER PROCEDURE
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.

18. AFTER PROCEDURE
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

19. AFTER PROCEDURE
May remove dressing/bandage another day,
or replace it if it becomes soiled or wet
R: To prevent from getting infection.
Resume patient regular diet.
R: To promote wound healing.

20. THANK YOU !!!