Thoracentesis

thoracocentesis & pericardiocentesis

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4. oThoracentesis 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’’

5. Diagnostic
•Pleural effusion
•Hemopneumothorax
•Empyema
Therapeutic
•Large peural effusion
•Relieve the symptoms

6. Coagulation disorder
Active skin infection
Atelectasis
Only one functioning lung
Emphysema
Severe cough or hiccups
An uncooperative patient

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.

9. 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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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

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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

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30. Pulmonary edema
Respiratory distress
Air embolism
Bleeding
Infection
Dyspnea and cough
Atelectasis

31. Pericardiocentesis

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
5
th
& 6
th
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.

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43. Risk and Complication
 Cardiac arrest
Myocardial infarction
Heart attack
Laceration of heart
muscle
Arrythmias
Laceration of organs
Puncture of coronary
arteries
Hemothorax
Pneumothorax
Pneumohemothorax