Thoracentesis 12 june 2020

Seema Varghese, Chirayu College of Nursing, Bhopal

1. 1 DEMONSTRATION ON THORACENTESIS Presented by: Mrs Seema Varghese

2. Objectives Define thoracentesis Enlist its purpose, indications Enumerate instruments Explain pre procedure care Explain during procedure care Describe post procedure care List out complications

3. Introduction Thoracentesis, also known as thoracocentesis , pleural tap, needle thoracostomy , or needle decompression.

4. D EF I N I T I ON  Thoracentesis is the insertion of a large bore needle through the chest wall into the pleural space to obtain specimen for diagnostic evaluation or removal of fluid. .

5. Pleural Space

6. PU R PO SE S  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

7. I NDICA T I ON S

8. CONTRAINDICATION S  Coagulation disorder  An uncooperative patient  Only one functioning lung  Severe cough or hiccups  Local Infection (Cellulitis/ herpes zoster)

9. Prepare Equipment s  Thoracentesis tray  Pigtail catheter  Connecting tubing  Syringe 50ml and 5ml  Scapel blade and blade 11  Needles ( 22 and 2 5 g a u g e)   Sterile Glove Mask  Povidone / Alcohol  Local anaesthetic, e.g. lignocaine (lidocaine) 1% or 2 %  C+S bottle  3-way stopcock  Bottle with rubber cap Sterile occlusive dressing Cardiac table with pillow

10. Pigtail Catheter

11. Kelly clamp or hemostat

12. 7 Nursing Responsibilities

13. BEFORE THE PROCEDURE  Assess the condition of the patient  Explain the purpose, risks/benefits, and steps of the procedure and obtain consent from the patient or appropriate legal guardian. R : An explanation helps orient the patient to the procedure assist in coping and provide an opportunity to ask question and verbali z e anxiety  Keep ready chest x-ray

14. Cont… Using ultrasonography to identify a site for diagnostic thoracentesis R- significantly lower risk of pneumothorax 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.

15. C ont…  Administer a cough suppressant if indicated. R-Movement and coughing during the procedure may cause inadvertent damage to the lung or pleura.  IV access should be established Keep Atropine injection ready R- in case of profound vasovagal response  Administer supplemental oxygen R- prevents hypoxia 9

16. Cont…  Position the client upright, leaning forward with arms and head supported on an anchored overbed table. Physician spread the sterile drape R- This position spreads the ribs, enlarging the intercostal space for needle insertion.  Physician will explain that he/she will receive a local anesthetic (1%/ 2% lidocaine) R: to minimize pain during the procedure.  Physician cleans patient skin with antiseptic solution R: To prevent infection and maintain aseptic technique.

17. Position

18. Midclavicular

19. Anesthetize

20. 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

21. Cont… A simple assessment, such as listening to the lungs with a stethoscope and Percussion (tapping on the lung area with a finger) can indicate extra fluid. R- to locate the area of insertion and to assess maximum degree of dullness

22. Locating the site

23. Cont… Marking: 2 inches below from the area of dullness starts R- for easy drainage of fluid Fluid usually 1000ml -1200 ml of pleural fluid is removed ( per day maximum) . Monitor for hypotension, hypoxemia R- avoid rapid removal of fluid

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

25. Post procedure care Apply a dressing over the puncture site and position on the unaffected side for 1 hour. R-This allows the pleural puncture to heal. Label obtained specimen with name, date, source, and diagnosis; send specimen to the laboratory for analysis. R- Fluid obtained during thoracentesis may be examined for abnormal cells, bacteria, and other substances to determine the cause of the pleural effusion.

26. Cont… During the first several hours after thoracentesis, frequently assess and document vital signs; oxygen saturation; respiratory status and puncture site for bleeding R-Frequent assessment is important to detect possible complications of thoracentesis, such as pneumothorax . Obtain a chest X-ray. R- Chest X-ray is ordered to detect possible pneumothorax . Normal activities generally can be resumed after 1-2 hour if no evidence of pneumothorax or other complication is present. R- The puncture wound of thoracentesis heals rapidly.

27. Cont…  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. Cont…  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.

29. COMPLICATION S Bleeding Infection Respiratory distress due to multiple needle insertion Pneumothorax Intra-abdominal injury (liver/ spleen/ diaphragm)

30. Intra-abdominal injury

31. Conclusion Thoracentesis is a minimally invasive procedure used to diagnose and treat pleural effusions, a condition in which there is excess fluid in the pleural space, also called the pleural cavity. This space exists between the outside of the lungs and the inside of the chest wall.

32. Bibliography Black J. M. and Hawks J (2009) Medical –surgical Nursing, Clinical Management for positive outcomes (8 th edition) Saunders , Elsevier PP-620-621 Lewis S. M., Heitkemper M. M and Dirksen S. R (2007) Medical /Surgical Nursing. Assessment and management of clinical problems. (7 th edition) St Louis: C.V. Mosby PP-530, 550-560

33. THANK YOU !!!