Thoracentesis is a procedure to remove fluid or air from the pleural cavity through insertion of a needle into the chest wall. It is indicated for conditions such as pleural effusion, pneumonia, or trauma. The nurse prepares equipment like syringes, needles, and specimen containers and assists the physician by administering local anesthetic, observing for complications, and providing aftercare like monitoring for bleeding or infection. Precise technique and positioning are important to safely drain fluid and avoid injuries to lungs during the procedure.

1. M.PRADEEP
M.S.C.NURSING
1ST YEAR

2. INTRODUCTION:
 Thoracentesis is defined as introducing
a hollow needle into plueral cavity and
aspirating fluid or cu r, using aseptic
technique
 Thoracentesis refer to the puncture by
needle through the chest wall into the
pleural space for the purpose of
removing pleural fluid (blood, serous
fluid, pus, etc.) and/or air
(pneumothorax)

3. DEFINITION:
 Thoracentesis or pleural aspiration or
pleural lap is the insertion of needle into
the pleural space through the chest wall
to remove the pleural fluid or possibly
air.

4. PURPOSES:
 To remove excessive pleural fluid (serous fluid, blood or
pus).
 To drain fluid /air from pleural cavity for diagnostic or
therapeutic purposes.
 To introduce medications
 To aid in full expansion of lung
 To obtain specimen for biopsy
 To take pleural biopsy for diagnostic examination
 To relieve pain
 To relieve breathlessness caused by accumulation of fluid
or air in the pleural space
 To aid in diagnosis and treatment (chemical,
bacteriological, cellular, composition and malignancy)

5. INDICATIONS:
 Traumatic pneumothorax.
 Hemopneumothorax.
 Spontaneous pneumothorax.
 Bronchopleural fistula.
 Pleural effusion
 For diagnostic purpose
 Therapeutic purpose ( reduced
dyspnea)

6. GENERAL
INSTRUCTIONS:
 The patient should be prepared physically and
psychologically for the procedure
 Thoracentesis is indicated in case of pleural effusion due
to infection, traumatic injury, cancer or cardiac diseases.
Etc
 Common site for thoracentesis is just below the scapula
at the seventh or eighth intercostal space
 The patient should be warned that any sudden
movements during the procedure may cause injury to the
lungs, blood vessels, etc
 The level of the aspiration needle should be short to
prevent prickling of the lungs
 Usually upright position is used during the procedure as it
helps to collect the pleural cavity and hence facilitates to
remove the fluid easily

7. Cont.,
 Maintain strict aseptic technique to prevent
introduction of Infection into the pleural space.
 The three way adaptor should be fitted with the
 needle before it is introduced into the chest cavity.
The adaptor should be in a closed position to prevent
the entry of air in to the pleural cavity.
 The nurse should check the syringes and needle
 for air-tightness. If these are not air-tight, then air will
enter the pleural cavity, which causes the lung
collapse.
 Remove the fluid slowly and not more than 1,000 ml
at a time, if the tap is therapeutic, to prevent
mediastinal shift.

8. Cont.,
 Use water-seal drainage system, if pleural
fluid is purulent and difficult to drain.
 The specimen should be sent to the
laboratory soon after it is collected.
 The aspiration should be discontinued if
any signs of complications are noted such
as sharp pain, respiratory distress,
excessive coughing, crepitushemoptysis,
circulatory collapse, etc.

9. PRELIMINARY
ASSESSMENT:
Check
 The doctors order for any specific instructions.
 Written informed consent of the patient or relatives.
 General condition and diagnosis of the patient.
 Review fresh erect chest Xray.
 Confirm the diagnosis, location and extent of the
pleural air/fluid/pus.
 Acute respiratory insufficiency (tension
pneumothorax, rapidly developing effusion without
dyspnea) may demand thoracentesis without Xray..
 Mental status of the patient to follow instructions.
 Articles available in the unit.

11. PREPARATION OF THE
PATIENT AND THE
ENVIRONMENT:
 Explain the sequence of the procedure
 Provide privacy.
 Chest Xray should be taken before
thoracentesis to diagnose the location.
 Check the vital signs and record it on
the nurse's record for reference.
 A mild sedative may be given of the
patient before starting the procedure.

12. Cont.,
 Maintain the desired position of the patient,
during the procedure.
 The nurse should remain near the patient-
to observe and to remind not to move
during the procedure.
 Arrange the articles at the bed side or in
the treatment room.
 9. Premedication: injection atropine sulfate
of 0.65mg is given intramuscularly or
intravenously half an hour before the
procedure.

13. EQUIPMENTS:
A Sterile Tray
 Dissecting forceps-I.
 Sponge holding forceps-1.
 Syringe (5ml) and 2 needles for giving local
anesthesia.
 Syringe (20ml) with 1 leur lock to aspirate the fluid.
 Aspiration needle number 16 (long and short).
 Three way stopcock.
 Small bowls-2, to take cleaning lotions
 Specimen bottles and slides.
 Cotton swabs, gauze pieces and cotton pads.
 Gown, masks and gloves for the doctor.
 Sterile dressing towels/slit.

14. Cont.,
 An Unsterile/Clean Tray
 Mackintosh and towel.
 Kidney tray and paper bag.
 Spirit, tincture of iodine and benzoin
 Lignocaine 2 percent.
 Suction apparatus with water seal
drainage system

15. PROCEDURES:
 Position the patient in Fowlers. Bring patient to one
side of bed with feet supported, arms and head
leaning forward on cardiac table with pillows.
 Untie gown to expose the site for aspiration.
 Instinct patient to avoid coughing and to remain
immobile during procedure.
 Explain that a feeling of deep pressure will be
experienced, while fluid is being aspirated from
pleural space.
 Provide sterile gloves to doctor.
 Open sterile set and assemble 20 ml, 50 ml
syringes, 20-22 G needles and aspiration needle.
 Pour antiseptic solution to clean site.

16. Cont.,
 After showing label to.doctor clean top of local
anesthetic bottle and assist to withdraw
mediation
 Reassure patient and instruct to hold breath
during insertion of aspiration needle.
 As physician does procedure, observe for
signs and symptoms of complications
 After fluid is withdrawn from pleural
space,transfer to specimen container.
 After needle is withdrawn, apply pressure over
puncture site. Assist in sealing the site with
tincture of benzoin swab.

19. AFTER CARE:
 Instruct patient In lie on non-affected site for 1 hour, ensue bed
rest for 6 to 8 hours
 Monitor vital signs every half hour until stable.
 Observe patient for signs Symptoms of hemothorax, tension
pneumothorax, subcutaneous emphysema and air embolism.
 Administer analgesics and antibiotics are prescribed.
 Instruct patient Io carrv out deep breathing exercises.
 A chest Xrav may be taken to determine the effect of the
procedure.
 The puncture site should be treated aseptically to prevent
contamination of the wound.
 The container with aspirated fluid should be labeled and sent to
the laboratory with requisition form.
 Replace the articles after cleaning.
 Wash hands thoroughly.
 Record the procedure in the nurse’s record sheet

21. COMPLICATIONS:
 Pneumothorax and hemothorax
 Tension pneumothorax
 Mediastinal shift
 Pulmonary edema