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  2. 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. 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. 4. INDICATIONTraumatic pneumothoraxHemopneumothoraxSpontaneous pneumothoraxBronchopleural fistulaPleural effusion
  5. 5. CONTRAINDICATION An uncooperative patient Coagulation disorder Atelectasis Only one functioning lung Emphysema(pulmonary enlargement) Severe cough or hiccups
  6. 6. COMPLICATION Pulmonary edema  Bleeding Respiratory distress  Infection Air embolism  Dyspnea and cough Cardiac tamponade(fluid build up in the space  Atelectasis(lung between myocardium and collapes) pericardium)
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  8. 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. 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 9
  10. 10. • Prepare Equipment Dressing set  Povidone / Alcohol Abraham’s needle  Local anaesthetic, e.g. lignocaine (lidocaine) 1% Connecting tubing or 2% Syringe 50ml and 5ml  Formalin bottle Scapel blade and blade 11  Urine bottle x2 Needles (18 and 23  C+S bottle gauge)  3-way stopcock Sterile Glove  Fenestrated towel Mask  Jug
  11. 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. 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.
  13. 13. 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
  14. 14. 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.
  15. 15. 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.
  16. 16. 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.
  17. 17. 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 dont have complications
  18. 18. 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.
  19. 19. THANK YOU !!!