Thoracentesis is a procedure to drain fluid from the pleural space between the lungs and chest wall. It is done to determine the cause of fluid accumulation, relieve symptoms like shortness of breath, and as a diagnostic or treatment procedure. The doctor will take a medical history, prepare equipment, position the patient upright, clean the skin, and administer local anesthetic. During the procedure, vital signs and breathing are monitored. Afterward, a chest x-ray is taken, fluid samples are labeled and sent for testing, and the patient rests in bed while being monitored for complications before resuming regular activities.

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Thoracentesis

2. DEFINITION
Thoracentesis is a procedure to
remove fluid from the space
between the lungs and the chest
wall called the pleural space.
Thoracentesis is a procedure that
removes an abnormal accumulation
of fluid or air from the chest
through a needle or tube.

3. PURPOSETo determine the cause of abnormal
accumulation of fluid in the pleural
space.
Relieve shortness of breath and pain
As a diagnostic or treatment procedure
To drain large amounts of pleural fluid
To equalize pressure on both sides of
the thoracic cavity

4. INDICATION
 Traumatic pneumothorax
 Hemopneumothorax
 Spontaneous pneumothorax
 Bronchopleural fistula
 Pleural effusion

5. CONTRAINDICATION
An uncooperative patient
Coagulation disorder
Atelectasis
Only one functioning lung
Emphysema(pulmonary enlargement)
Severe cough or hiccups

6. COMPLICATION
▪ Pulmonary edema
▪ Respiratory distress
▪ Air embolism
▪ Cardiac tamponade(fluid
build up in the space
between myocardium and
pericardium)
▪ Bleeding
▪ Infection
▪ Dyspnea and
cough
▪ Atelectasis(lung
collapes)

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8. BEFORE THE PROCEDURE
Explain the purpose,
risks/benefits, and steps of the
procedure and obtain consent from
the patient or appropriate legal
design.
• An explanation helps orient the
patient to the procedure assist in
coping and provide an opportunity
to ask question and verbalise
anxiety

9. CON’T…
Take Medical History such as
➢Trouble in breathing, coughing, and hiccups
➢Had heart disease
➢Smoked
➢Travelled to places where may have been
exposed to tuberculosis
R: to detect any abnormalities regarding
the procedure
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10. • Prepare Equipment
 Dressing set
 Abraham’s needle
 Connecting tubing
 Syringe 50ml and
5ml
 Scapel blade and
blade 11
 Needles (18
and 23 gauge)
 Sterile Glove
 Mask
 Povidone / Alcohol
 Local anaesthetic,
e.g. lignocaine
(lidocaine) 1%
 or 2%
 Formalin bottle
 Urine bottle x2
 C+S bottle
 3-way stopcock
 Fenestrated towel
 Jug

11. BEFORE THE PROCEDURE
 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
To prevent complication such as
bleeding while during procedure.

12. Place patient upright / cardiac position and
help patient maintain position during
procedure.
R: the upright position ensures that the
diaphragm is more dependent and facilitates
the removal of fluid that usually localizes at
the base of the chest.
Explain that he/she will receive a
local anesthetic
R: to minimize pain during the procedure.
Clean patient skin with antiseptic soap
R: To prevent infection and maintain
aseptic technique.

14. 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

15. DURING PROCEDURE
Monitor saturation R:
To prevent hypoxia
Inform doctor if any changes of the patient
R: To make sure whether need to continue the
procedure or stop immediately.

16. AFTER PROCEDURE
 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.
 Check that each bottle is correctly
labelled by checking patient identifiers-
full name, date of birth and/or medical
record number then send to the lab tests
 R: To prevent from incorrect results to the patient.

17. AFTER PROCEDURE
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.

18. AFTER PROCEDURE
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

19. AFTER PROCEDURE
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.

20. THANK YOU !!!