Thoracentesis is a procedure to remove fluid from the pleural space by inserting a needle between the ribs and into the pleural cavity. It is done both diagnostically to evaluate pleural effusions and therapeutically to drain large fluid collections. The document outlines the indications, contraindications, necessary equipment and supplies, step-by-step procedure, monitoring after the procedure, potential risks and complications, and documentation required.

1. 1

3. 3

4. o Thoracentesis is a percutaneous procedure
during which a needle is inserted into the
pleural space and pleural fluid is removed
either through the needle or a catheter.
o ‘’Pleural tap’’ OR ‘’pleural fluid aspiration’’

5.  Diagnostic
• Pleural effusion
• Hemopneumothorax
• Empyema
 Therapeutic
• Large peural effusion

6.  Coagulation disorder
 Active skin infection
 Atelectasis
 Only one functioning lung
 Emphysema
 Severe cough or hiccups


7.  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

8. Do Diagnostic Tests such as
 Chest X-ray
 Ultrasound
R: to determine the affected lung
 Check platelet count and/or presence of
coagulopathy
R: To prevent complication such as bleeding during
procedure.

9.  Dressing set
 Abraham’s needle
 Connecting tubing
 Syringe
 Needles (18 and 23
gauge)
 Sterile Glove
 Mask
 Povidone / Alcohol
 Local anaesthetic
 Formalin bottle
 Urine bottle x2
 C+S bottle
 3-way stopcock

10. 10

11. 11

12. 12

13. 13

14. 14

15. 15

16.  Place patient upright position
R: Ensures that the diaphragm is more
dependent and facilitates the removal of
fluid.
The lateral recumbent position if the
patient is unable to sit upright.
BEFORE THE
PROCEDURE

18. 18

19. 19

20. 20

21.  Explain that he/she will receive a local
anesthetic
R: to minimize pain during the procedure.
 Clean patient skin with antiseptic
R: To prevent infection and maintain
aseptic technique.
21

22. 22

23. 23

24.  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.

25.  Observe patient level of consciousness and give
emotional support
R: To reduce patient anxiety
 Monitor saturation
R: To prevent hypoxia
 Drain max 1.5 L in one sitting
R: avoid re-expansion pulmonary edema
25

26.  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.
 correct labelling of specimen bottle then send to
the lab
R: To prevent incorrect results to the patient.

27.  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.  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 don't have complications

29. 29

30.  Pulmonary edema
 Respiratory distress
 Air embolism
 Bleeding
 Infection
 Dyspnea and cough
 Atelectasis

31. Pericardiocentesis

32. A therapeutic and diagnostic procedure in
which fluid is removed from the pericardial
space..

33. Cardiac Tamponade:
It is an abnormal accumulation of fluid in the
pericardial space, resulting in reduced ventricular
filling and subsequent hemodynamic compromise

34.  Echocardiogram or ultrasound to identify
 Fluid quantity
 Coagulation
 Loculation
 Discontinue anticoagulants
 Informed consent
 full facilities for resuscitation

35.  Table for central line insertion with
 chlorhexidine for skin
 dressing pack
 sterile drapes
 local anesthetic (lidocaine 2%)
 syringes (including a 50 mL)
 needles (25G and 22G)
 Pericardiocentesis needle (15 cm, 18G) Wallace
cannula

36.  Dilators (up to 7 French)
 Pigtail catheter (60 cm with multiple side holes)
 Drainage bag and connectors
 Facilities for fluoroscopy or echocardiography

37. Position the patient at ~30°
Sedate lightly with midazolam
Wear sterile gown and gloves
clean the skin from mid-chest to mid-abdomen
sterile drapes on the patient

38. Identify the anatomic landmark
Xiphoid process
5th
& 6th
ribs
Select a site for needle insertion
Most commonly used sites
Left sternocostal margin
Subxiphoid approach..
Procedure

39. Infiltrate the skin and subcutaneous tissues with local
anesthetic
Starting 1–1.5 cm below the xiphoid and left of midline
Staying close to the inferior border of the rib cartilages.
Insert the needle
b/w xiphoid and left costal margin
Angled at ~30°
Advance slowly,
Aspirating & injecting lidocaine
Aiming for the left shoulder

40. Aspirate during insertion
stop advancing the needle Once fluid is encountered
continue aspirating
Reassess for improvement
repeated if necessary
Procedure

41. After the procedure
 Tube is left connected to drainage bottle
no more fluid drained
no accumulation of fluid in the pericardium
 Echocardiogram to monitor clearance of fluid.
 Monitor
blood pressure
pulse
neck veins
The fluid should be tested for identification of
the cause.

42. 42

43. Risk and Complication
 Cardiac arrest
Myocardial infarction
Heart attack
Laceration of heart
muscle
Arrythmias
Laceration of organs
Puncture of coronary
arteries
Hemothorax
Pneumothorax
Pneumohemothorax