thoracentesis final

1. 1
Thoracentesis

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. PURPOSETo 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)

7. 7

8. BEFORE THE PROCEDURE
Explain the purpose,
risks/benefits, and steps of the
procedure and obtain consent from
the patient or appropriate legal
design.
• 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
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 !!!