Seminar Presentation

1. M.PRADEEP
M.S.C.NURSING
1ST YEAR

2. INTRODUCTION:
 Thoracentesis is defined as introducing
a hollow needle into plueral cavity and
aspirating fluid or cu r, using aseptic
technique
 Thoracentesis refer to the puncture by
needle through the chest wall into the
pleural space for the purpose of
removing pleural fluid (blood, serous
fluid, pus, etc.) and/or air
(pneumothorax)

3. DEFINITION:
 Thoracentesis or pleural aspiration or
pleural lap is the insertion of needle into
the pleural space through the chest wall
to remove the pleural fluid or possibly
air.

4. PURPOSES:
 To remove excessive pleural fluid (serous fluid, blood or
pus).
 To drain fluid /air from pleural cavity for diagnostic or
therapeutic purposes.
 To introduce medications
 To aid in full expansion of lung
 To obtain specimen for biopsy
 To take pleural biopsy for diagnostic examination
 To relieve pain
 To relieve breathlessness caused by accumulation of fluid
or air in the pleural space
 To aid in diagnosis and treatment (chemical,
bacteriological, cellular, composition and malignancy)

5. INDICATIONS:
 Traumatic pneumothorax.
 Hemopneumothorax.
 Spontaneous pneumothorax.
 Bronchopleural fistula.
 Pleural effusion
 For diagnostic purpose
 Therapeutic purpose ( reduced
dyspnea)

6. GENERAL
INSTRUCTIONS:
 The patient should be prepared physically and
psychologically for the procedure
 Thoracentesis is indicated in case of pleural effusion due
to infection, traumatic injury, cancer or cardiac diseases.
Etc
 Common site for thoracentesis is just below the scapula
at the seventh or eighth intercostal space
 The patient should be warned that any sudden
movements during the procedure may cause injury to the
lungs, blood vessels, etc
 The level of the aspiration needle should be short to
prevent prickling of the lungs
 Usually upright position is used during the procedure as it
helps to collect the pleural cavity and hence facilitates to
remove the fluid easily

7. Cont.,
 Maintain strict aseptic technique to prevent
introduction of Infection into the pleural space.
 The three way adaptor should be fitted with the
 needle before it is introduced into the chest cavity.
The adaptor should be in a closed position to prevent
the entry of air in to the pleural cavity.
 The nurse should check the syringes and needle
 for air-tightness. If these are not air-tight, then air will
enter the pleural cavity, which causes the lung
collapse.
 Remove the fluid slowly and not more than 1,000 ml
at a time, if the tap is therapeutic, to prevent
mediastinal shift.

8. Cont.,
 Use water-seal drainage system, if pleural
fluid is purulent and difficult to drain.
 The specimen should be sent to the
laboratory soon after it is collected.
 The aspiration should be discontinued if
any signs of complications are noted such
as sharp pain, respiratory distress,
excessive coughing, crepitushemoptysis,
circulatory collapse, etc.

9. PRELIMINARY
ASSESSMENT:
Check
 The doctors order for any specific instructions.
 Written informed consent of the patient or relatives.
 General condition and diagnosis of the patient.
 Review fresh erect chest Xray.
 Confirm the diagnosis, location and extent of the
pleural air/fluid/pus.
 Acute respiratory insufficiency (tension
pneumothorax, rapidly developing effusion without
dyspnea) may demand thoracentesis without Xray..
 Mental status of the patient to follow instructions.
 Articles available in the unit.

11. PREPARATION OF THE
PATIENT AND THE
ENVIRONMENT:
 Explain the sequence of the procedure
 Provide privacy.
 Chest Xray should be taken before
thoracentesis to diagnose the location.
 Check the vital signs and record it on
the nurse's record for reference.
 A mild sedative may be given of the
patient before starting the procedure.

12. Cont.,
 Maintain the desired position of the patient,
during the procedure.
 The nurse should remain near the patient-
to observe and to remind not to move
during the procedure.
 Arrange the articles at the bed side or in
the treatment room.
 9. Premedication: injection atropine sulfate
of 0.65mg is given intramuscularly or
intravenously half an hour before the
procedure.

13. EQUIPMENTS:
A Sterile Tray
 Dissecting forceps-I.
 Sponge holding forceps-1.
 Syringe (5ml) and 2 needles for giving local
anesthesia.
 Syringe (20ml) with 1 leur lock to aspirate the fluid.
 Aspiration needle number 16 (long and short).
 Three way stopcock.
 Small bowls-2, to take cleaning lotions
 Specimen bottles and slides.
 Cotton swabs, gauze pieces and cotton pads.
 Gown, masks and gloves for the doctor.
 Sterile dressing towels/slit.

14. Cont.,
 An Unsterile/Clean Tray
 Mackintosh and towel.
 Kidney tray and paper bag.
 Spirit, tincture of iodine and benzoin
 Lignocaine 2 percent.
 Suction apparatus with water seal
drainage system

15. PROCEDURES:
 Position the patient in Fowlers. Bring patient to one
side of bed with feet supported, arms and head
leaning forward on cardiac table with pillows.
 Untie gown to expose the site for aspiration.
 Instinct patient to avoid coughing and to remain
immobile during procedure.
 Explain that a feeling of deep pressure will be
experienced, while fluid is being aspirated from
pleural space.
 Provide sterile gloves to doctor.
 Open sterile set and assemble 20 ml, 50 ml
syringes, 20-22 G needles and aspiration needle.
 Pour antiseptic solution to clean site.

16. Cont.,
 After showing label to.doctor clean top of local
anesthetic bottle and assist to withdraw
mediation
 Reassure patient and instruct to hold breath
during insertion of aspiration needle.
 As physician does procedure, observe for
signs and symptoms of complications
 After fluid is withdrawn from pleural
space,transfer to specimen container.
 After needle is withdrawn, apply pressure over
puncture site. Assist in sealing the site with
tincture of benzoin swab.

19. AFTER CARE:
 Instruct patient In lie on non-affected site for 1 hour, ensue bed
rest for 6 to 8 hours
 Monitor vital signs every half hour until stable.
 Observe patient for signs Symptoms of hemothorax, tension
pneumothorax, subcutaneous emphysema and air embolism.
 Administer analgesics and antibiotics are prescribed.
 Instruct patient Io carrv out deep breathing exercises.
 A chest Xrav may be taken to determine the effect of the
procedure.
 The puncture site should be treated aseptically to prevent
contamination of the wound.
 The container with aspirated fluid should be labeled and sent to
the laboratory with requisition form.
 Replace the articles after cleaning.
 Wash hands thoroughly.
 Record the procedure in the nurse’s record sheet

21. COMPLICATIONS:
 Pneumothorax and hemothorax
 Tension pneumothorax
 Mediastinal shift
 Pulmonary edema