Seema Varghese, Chirayu College of Nursing, Bhopal

1. 1
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. DEFINITION
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. PURPOSES
 To determine the cause of abnormal
accumulation of fluid in the pleural space.
Relieve shortness of breath and pain
A s a diagnostic or treatment procedure
To drain large amounts of pleural fluid

7. INDICATIONS

8. CONTRAINDICATIONS
Coagulation disorder
A n uncooperative patient
Only one functioninglung
Severe cough or hiccups
Local Infection (Cellulitis/ herpes zoster)

9. • Prepare Equipments
Thoracentesis tray
Pigtail catheter
Connecting tubing
Syringe 50ml and 5ml
Scapel blade and blade 11
Needles (22 and 25
gauge)


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 verbalize
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. Cont…
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. COMPLICATIONS
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
1. Black J. M. and Hawks J (2009) Medical –surgical
Nursing, Clinical Management for positive outcomes
(8th edition) Saunders, Elsevier PP-620-621
2. Lewis S. M., Heitkemper M. M and Dirksen S. R
(2007) Medical /Surgical Nursing. Assessment and
management of clinical problems. (7th edition) St
Louis: C.V. Mosby PP-530, 550-560

33. THANK YOU !!!