This document provides instructions for removing air or fluid from the pleural cavity via a procedure called a thoracentesis. It lists common reasons for needing the procedure such as pneumothorax, empyema, or malignant pleural effusion. It then outlines the necessary steps including getting imaging, administering local anesthetic, inserting a chest tube between the ribs, attaching it to suction, and monitoring for complications. The goal is to fully re-expand the lung and ensure no further air leaks or bleeding once drainage has ceased.

1. Emergency
Remove air or fluid from pleural cavity
By dr sumer yadav

2.  Pneumothorax
 Empyema
 Malignant pleural effusion
 Traumatic hemopneumothorax
 Postoperative after esophageal,cardiac
,pulmonary surgery

3.  Lung adherent to chest wall
 Uncorrected coagulopathy

4.  Check x ray/usg/ct
 Consent
 Iv line
 Aspirate and confirm
 5 ICS MAL
 Safty triangle;ant border of latisimus
dorsi,lat border of pectoralis major,line hz to
nipple ,apex towards axilla
 Loculated coll use usg guided insertion

5.  For pneumo 22 to 24 fr
 For hemo 28 to 30 fr
 Supine position most common in use ,with
arm below head
 In sitting posture leaning over cardiac trolley
required

6.  Inject local
 Incision given
 Track dilated
 Ask pt to stop breathing during insertion
 If pt on ventilator,disconnect during insertion
 Attach to underwater seal drain
 Push tube
 Any tube position can drain air or fluid
 Apply purse string suture tightly and fix drain

7.  Encourage to take deep breaths
 Hold deep inspiration
 One time drain only 1 ltr
 To prevent reexpainson pulnonary edema
 Keep bottle upright and below chest
 Auscultate and cxr
 Milk tube
 Analgesics

8.  Fully expanded lung
 No hemo,pneumo
 No air leak
 No fresh or altered bld coming
 Daily drainage <100 cc

9.  Ask pt to hold breath at end of inspiration
 Remove,tighten suture
 Auscultate and cxr