Thoracentesis Bsc h nursing Medical surgical nursing

1. MEDICAL SURGICAL NURSING
THORACENTESIS
SUBMITTED TO:-. SUBMITTED BY:-
RESP.KIRTI MA’AM. SIMRAN ANAND
FACULTY. B.SC(H)NSG 4TH YR.
CON,VMMC&SJH. 03150306619

2. THORACENTESIS
Thoracentesis refers to a procedure In which
puncture made by needle through the chest
wall into the pleural space for the purpose of
removing an abnormal accumulation of fluid
(blood,serous fluid,pus,etc.)or air
(pneumothorax).

4. Introduction to Anatomy of
Lung :-
 The lungs are located in the chest on either side of the heart
in rib cage. They are conical in shape with a narrow rounded
apex at the top and a broad based base which rests on
diaphragm.
 The lungs are surrounded by the pulmonary pleurae,the
outer parietal lines the inner wall of rib cage and the inner
visceral pleura lines the surface of the lungs. Between them is
a space called pleural Cavity containing pleural fluid.

7. Layers of pleural membrane

8. Purpose
 To study the chemical ,bacteriological and cellular composition
of the pleural fluid,cellular composition which may reveal the
presence of neoplastic cells.
 To remove excessive fluid(pleural)which become infected and
cause empyema.
 As a diagnostic procedure Or treatment procedure.
 To relieve lung compression pain and respiratory distress
caused by fluid accumulation.

9. Indication for Thoracentesis
Traumatic pneumothorax
Haemothorax
Hemopneumothorax
 Bronchopleural fistula
Pleural effusion

10. Position for Thoracentesis
1.Have the client seated at the edge of the bed with feet supported
on a stool .place an over bed table infront of the client.place a soft
pillow over the table and have the client lean over pillow with
arms,shoulders and head resting on it.

11. 2. client is positioned in a
Fowler’s position resting on
the unaffected side.The
hand of the affected side is
raised over the head or
place the palm resting on
the oppsosite shoulders.
If the client is too ill to
maintain an upright
position,turn the client on
the unaffected side and
place the arm of the
affected side over the head.

12.  3. If the client is able to get out of the bed then have the client
seated on a chair and turned towards the back of the chair and
leaning over its back with the arms and shoulders raised .

13. Site for Thoracentesis
The common site for
the pleural aspiration is
the area just below the
inferior angle of
scapula at the 7th
intercostal space in the
midscapular line or
posterior axillary line(
6-10 cm lateral to
spine).

15. General instructions for Thoracentesis
 Prepare patient mentally and physically .provide adequate
explanation about the procedure and gain confidence.
 Warn the patient that any sudden movement may cause
injury to the lungs,blood vessels etc. Remain the patient .If
he coughs ,remove the needle.
 The 3 way adaptor is fitted with the needle before it is
introduced into the chest cavity .close it to prevent the
entry of air.
 The bevel of the aspiration needle should be kept short to
prevent pricking of the lung.

16.  The needle should not be inserted below the 9th intercostal
place to prevent piercing of liver and other abdominal organs
.
 Check the syringe and needles for air tightness,to prevent air
entry and hence collapse of lungs.
 The amount of fluid withdrawn should not be more than 1000
ml at a time as it may lead to mediastinal shift due to removal
of a large amount of fluid .
 The suction exerted by the syringe should be minimal to
prevent sucking of the lung tissues into the needle.
 The nurse should remain with the Client during the procedure
and detect any complication at its earliest.

17.  Follow strict aseptic technique to prevent introduction of
infection .
 If any signs of infection are noted such as sharp
pain,excessive coughing ,crepitus,hemoptysis etc.then the
procedure is discontinued .
 The specimens should be sent to the lab soon after collected
as it tends to coagulate easily .
 If the fluid content is purulent,it may cause difficulty to drain
the fluid .A closed water seal drainage system may be set up.

18. NURSE’S RESPONSIBILITY
PRELIMINARY ASSESSMENT :
 Check Name and Age of the client.
 Check the MRD no.of the client .
 Check the diagnosis of the client.
 Check the purpose of the procedure.
 Check the previous history of the patient.

19. Preparation of articles :
Sterile tray containing:-
 Sponge holding forcep
 Syringe 5ml and 20ml
 2 Needle for giving local anaesthesia
 Aspiration needle ,16G (long and short)
 3 way adapter
 Small bowls,2
 Specimen bottles,3
 Sterile dressing towel (slit)
 Gauze piece,cotton pads

22. Clean tray containing:-
Mackintosh and towel
Kidney tray and paper bag
Spirit and Butadiene
Lignocaine 2%
Suction apparatus with water seal drainage
system.
Adhesive tape,scissor
Chittle forcep
Gloves,Gown,Mask

23. Preparation of the client and unit:
 Identify the client correctly.
 Explain the procedure to the client and tell him
how can he cooperate.
 Check the consciousness of the client .
 Chest X-ray should be taken before the
procedure is done.
 The site for thoracentesis should be shaved ,
cleaned,and painted with skin antiseptic before
sending the client to the operation room.

24.  Check the vital signs and record in Nurse’s record.
 Mild sedative may be given to the client.
 Get a written consent from the client and his relatives.
 Change the client’s garments and collect his/her valuable.
 Maintain the desired position during the procedure.
 Maintain privacy of the client with screen and drapes.
 Arrange all the articles at the bedside of the client.
 Check the articles for their proper functioning .
 Adequate lightening in the room.

25. PROCEDURE OF THORACENTESIS:
 Wash hands before the procedure.
 Maintain the desired position during the procedure.
 The procedure is done under strict aseptic techniques.
 Giving a local anaesthesia at the puncture site.
 After aspiration needle fitted with a 3 way adapter is
introduced through the intercostal space into the pleural
cavity .
 The adapter Should be in a closed position to prevent the
air entering the pleural Cavity .

26.  As soon as the needle is in position the syringe is attached .
 The suction produced pulls the fluid from the chest cavity.
 The amount of fluid that is removed is usually about 20-30
ml.
 Specimen collected and send for examination in the lab.
 After enough fluid is removed the cannula is removed and
opening is sealed with suture ,cotton pad with pressure.

28. Contraindication
 An uncooperative patient
 Coagulation disorder
 Atelectasis
 Severe cough or hiccups
 Emphysema

29. Associated complication with
Thoracentesis
 Pulmonary Edema
 Respiratory distress
 Air embolism
 Bleeding
 Infection
 Dyspnea and cough
 Atelectasis

30. After care of the client and unit:
 Apply sterile dressing and pressure on the site as soon as the
needle is withdrawn .The wound should be sealed to prevent
leakage of fluid.
 The client should be positioned comfortably on the bed with
affected side up.
 Nurses observe the client for the early detection of complication .
 Serum electrolyte are carried out to find out any disturbance in
the electrolyte content of the blood.
 Replacement therapy is necessary When a large amount of fluid is
removed.
 A chest X-ray may be taken to determine the effects of the
procedure.

32.  The puncture site should be treated aseptically to
prevent contamination of the wound. It should not
get wet.
 The client should be asked for deep breathing
exercise which will help to expand the lungs.
 The container with aspirated fluid should be labelled
and sent to the laboratory.
 Record the procedure with date and time on the
Nurse’s record.
 Record the amount,colour,type of fluid,any
complication that has taken place during procedure.
 Wash and clean all articles used for procedure first in
cold water,then with warm soapy and rinse in clean