This document provides an overview of thoracentesis, including:
- Definition, indications, contraindications, techniques/procedure, materials, and complications of thoracentesis.
- Thoracentesis is a procedure to remove fluid from the pleural space, either for diagnostic purposes or to relieve symptoms. It is indicated for large pleural effusions or those requiring diagnostic analysis.
- Potential complications include pneumothorax, hemothorax, organ injury, and infection, though minor complications like pain or dry tap are more common. Proper patient preparation, anesthesia, positioning, and sterile technique are emphasized to reduce risks.
BRONCHOSCOPY is a procedure in which a hollow, flexible tube called a bronchoscope is inserted into the airways through the nose or mouth to provide a view of the TRACHEOBRONCHIAL tree.
It can also be used to collect bronchial and/or lung secretions and to perform tissue biopsy.
Thoracentesis (thor-a-sen-tee-sis) is a procedure that is done to remove a sample of fluid from around the lung.
The lung is covered with a tissue called the pleura. The inside of the chest is also lined with pleura.
The space between these two areas is called the pleural space.
This space normally contains just a thin layer of fluid, however, some conditions such as pneumonia, some types of cancer, or congestive heart failure may cause excessive fluid to develop (pleural effusion).
Thoracentesis, also known as pleural fluid analysis, is a procedure in which a needle is inserted through the back of the chest wall into the pleural space (a space that exists between the two lungs and the anterior chest wall) to remove fluid or air.
Pleural fluid analysis is the microscopic and chemical lab analysis of the fluid obtained during thoracentesis.
IndDiagnostic: determination of pleural effusion etiology (e.g. transudative versus exudative) usually requires the removal of 50 to 100mL of pleural fluid for laboratory studies. Most new effusions require diagnostic thoracentesis, an exception being a new effusion with a clear clinical diagnosis (e.g. CHF) with no evidence for superimposed pleural space infection
Therapeutic: reduce dyspnea and respiratory compromise in patients with large pleural effusions. This is typically achieved by removing a much larger volume of fluid compared to the diagnostic thoracentesis
ications
Thoracentesis is a procedure in which a needle is inserted into the pleural space between the lungs and the chest wall. This procedure is done to remove excess fluid, known as a pleural effusion, from the pleural space to help you breathe easier.
BRONCHOSCOPY is a procedure in which a hollow, flexible tube called a bronchoscope is inserted into the airways through the nose or mouth to provide a view of the TRACHEOBRONCHIAL tree.
It can also be used to collect bronchial and/or lung secretions and to perform tissue biopsy.
Thoracentesis (thor-a-sen-tee-sis) is a procedure that is done to remove a sample of fluid from around the lung.
The lung is covered with a tissue called the pleura. The inside of the chest is also lined with pleura.
The space between these two areas is called the pleural space.
This space normally contains just a thin layer of fluid, however, some conditions such as pneumonia, some types of cancer, or congestive heart failure may cause excessive fluid to develop (pleural effusion).
Thoracentesis, also known as pleural fluid analysis, is a procedure in which a needle is inserted through the back of the chest wall into the pleural space (a space that exists between the two lungs and the anterior chest wall) to remove fluid or air.
Pleural fluid analysis is the microscopic and chemical lab analysis of the fluid obtained during thoracentesis.
IndDiagnostic: determination of pleural effusion etiology (e.g. transudative versus exudative) usually requires the removal of 50 to 100mL of pleural fluid for laboratory studies. Most new effusions require diagnostic thoracentesis, an exception being a new effusion with a clear clinical diagnosis (e.g. CHF) with no evidence for superimposed pleural space infection
Therapeutic: reduce dyspnea and respiratory compromise in patients with large pleural effusions. This is typically achieved by removing a much larger volume of fluid compared to the diagnostic thoracentesis
ications
Thoracentesis is a procedure in which a needle is inserted into the pleural space between the lungs and the chest wall. This procedure is done to remove excess fluid, known as a pleural effusion, from the pleural space to help you breathe easier.
A cardiac event monitor is a device that you control to record the electrical activity of your heart (ECG). This device is about the size of a pager. It records your heart rate and rhythm. Cardiac event monitors are used when you need long-term monitoring of symptoms that occur less than daily
A brief awareness and knowledge about the insertion of NGT nasogastric Tube and feeding through it.
It contains an introduction, procedure, equipment needed, method of feeding etc
A cardiac event monitor is a device that you control to record the electrical activity of your heart (ECG). This device is about the size of a pager. It records your heart rate and rhythm. Cardiac event monitors are used when you need long-term monitoring of symptoms that occur less than daily
A brief awareness and knowledge about the insertion of NGT nasogastric Tube and feeding through it.
It contains an introduction, procedure, equipment needed, method of feeding etc
Pleural effusion may be defined figuratively as the juice, oozing from the leaky lingerie of the lung. However the text book definition is the abnormal accumulation of fluid in the pleural space due to disturbances in the forces that keep the pleural fluid economy in equilibrium...
procedure of thoracenthesis ( removal of water from thoacic cavuty full procedure by ganesh dalvi and tushar cahure uder the supervision of prof. krishna sananse
I have prepared this mainly for residents doing post graduation in respiratory medicine and medicine. Special thanks to Dr. Avinash Babu for the help on malignant pleural effusion. My references are mainly Lights' pleural diseases and BTS guidelines.
Nusing Management of CAD Symposia (English) presented at Hôpital Sacré Coeur in Milot, Haiti.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
In medicine, a central venous catheter ("central line", "CVC", "central venous line" or "central venous access catheter") is a catheter placed into a large vein in the neck (internal jugular vein), chest (subclavian vein or axillary vein) or groin (femoral vein)
This presentation was prepared by a 4th year medical student of All saints university,Dominica doing surgery rotation in milton cato memorial hospital,St.Vincent.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
4. INTRODUCTION
• Thoracentesis is a percutaneous procedure during which a
needle is inserted into the pleural space and pleural fluid is
removed.
• Thoracocentesis
1-Diagnstic : refers to removal of a small volume
of pleural fluid for analysis.
2-Threaputic : refers to removal of a large volume
of pleural fluid for relief of symptoms.
5. INDICATION
Thoracentesis is indicated for the symptomatic treatment of large
pleural effusions
pleural effusions of any size that require diagnostic analysis.
To determine the nature of the effusion (i.e.,
transudate, exudate)
To identify potential causes malignancy, infection).
6. Cont’d
There are two circumstances in which diagnostic
thoracentesis is usually not required:
-when there is a small amount of pleural fluid and
-a secure clinical diagnosis (e.g viral pleurisy) or
- when there is clinically obvious heart failure (HF)
without atypical features
7. Cont’d
Atypical features that should prompt consideration of
diagnostic thoracentesis in a patient with HF include
-A unilateral effusion, especially if it is left-sided
-Bilateral effusions that are of disparate sizes
-Pleurisy
-Fever
-Normal cardiac silhouette on chest radiograph
-An echocardiogram that is inconsistent with heart failure
-B-type brain natriuretic peptide (BNP) levels that are
inconsistent with heart failure
-An alveolar-arterial oxygen gradient that is larger than
expected
-The effusion does not resolve with heart failure therapy
8. CONTRAINDICATION
There are no absolute contraindications for thoracentesis. Relative
contraindications include the following:
Uncorrected bleeding diathesis
Chest wall cellulitis at the site of puncture
A very small volume of pleural fluid, with less than 1 cm
distance from the pleural fluid line to the chest wall on a
decubitus chest radiograph.
10. EQUIPMENT
Several commercially available medical devices are specifically
designed for performing thoracentesis. Such devices include the
following:
Arrow-Clarke Thoracentesis Device (Teleflex Medical,
Research Triangle Park, NC)
Argyle Turkel Safety Thoracentesis System (Covidien,
Mansfield, MA)
Critical CarIf a commercial use-specific device is not available, all
of the necessary equipment can be obtained from the supplies
located in most inpatient settings, critical care units (CCUs), or
emergency departments (Eds)
13. Cont’d
•
•
•
•
•
•
•
•
•
•
Thoracentesis device - This typically consists of an 8-French catheter over
an 18-gauge, 7.5-in. (19-cm) needle with a 3-way stopcock and, ideally, a
self-sealing valve
Self-assembled device, if a thoracentesis device is unavailable - Options
include using an 18-gauge needle or a 12-gauge intravenous (IV) catheter
connected to a 60-mL syringe and then to a stopcock after the needle is
removed from the 60-mL syringe
Injection needle – 22 gauge, 1.5 in. (3.81 cm)
Injection needle – 25 gauge, 1 in. (2.54 cm)
Luer-Lok syringe - 10 mL
Luer-Lok syringe - 5 mL
Luer-Lok syringe - 60 mL
Tubing set with aspiration/discharge device
Antiseptic - Chlorhexidine solution [Hibiclens] is preferred
Lidocaine - 1% or 2% solution, 10-mL ampule
14. Cont’d
•
•
•
•
•
•
•
•
Specimen cap for 60-mL syringe
Specimen vials or blood tubes
Drainage bag or vacuum bottle
Drape - 24 × 30 in., with 4-in. fenestration with adhesive strip
Sterile towels
Scalpel - No. 11 blade
Adhesive dressing - 7.6 × 2.5 cm
Gauze pad(s) - 4 × 4 in.
15. PATIENT PREPARATION
• Patient preparation includes adequate
Anesthesia
proper positioning
Anesthesia
local anesthesia : lidocaine
The skin
subcutaneous tissue
rib periostem
intercostal muscle and
partial pleura
should all be
well infiltrated with
local anesthesia
(lidocaine)
16. Cont’d
Positioning
Patients who are alert and cooperative are most comfortable in a
Seated position
Leaning slightly forward
Resting the head on the arms or hands on a pillow.
Unstable patients and those who are unable to sit up may be supine for the procedure
The patient is moved the extreme side of the bed,
The ipsilateral hand is placed behind the head and
a towel roll is placed under the contra lateral shoulder.
18. TECHNIQUE
① Selection of puncture site
Guided by Ultrasound or
Physical examination
Ultrasound guidance is definitely indicated for patients
with loculated effusions.
Physical examination is used to guide selection of puncture
site when
1-For patients with a nonloculated, free-flowing
effusion.
2- when ultrasound is not available
19. Cont’d
The following landmarks are employed In
P.Examination
1- One to two interspaces below the level at which
breath sounds decrease or disappear
percussion becomes dull, and
fremitus disappears
2- Above the ninth rib, to avoid sub diaphragmatic
puncture
3-Midway between the spine and the posterior axillary
line, because the ribs are easily palpated in this location.
20. • When performing a thoracentesis on an elderly patient,
it is prudent to choose a puncture site 9 to 10 cm lateral
to the spine, assuming that the fluid collection will be
equally accessible.
② A wide area surrounding the puncture site should be
sterilized with
- 0.05 percent chlorhexidine or
- 10 percent povidone-iodine solution
21. ③ A sterile drape is placed over the puncture site and sterile towels
are used to establish a large sterile field within which to work
22. ④
The skin, subcutaneous tissue, rib periosteum, intercostal
muscles, and parietal pleura should be well infiltrated with
anesthetic (lidocaine 1-2%)
The epidermis is initially infiltrated with anesthetic
using a syringe and 25-gauge needle.
Next, a syringe with a 22-gauge needle is inserted,
advanced toward the rib, and then "walked" over the superior edge
of the rib
.
23. Cont’d
•
•
As the needle is advanced, aspiration should be attempted by
intermittently pulling back on the plunger of the syringe.
Anesthetic is injected if there is no return of blood or
pleural fluid into the syringe.
Intermittent aspiration serves two purposes.
1-blood return indicates that the needle is
intravascular and prevents the operator from injecting
anesthetic intravascularly.
•
2- pleural fluid return indicates that the needle has
entered the pleural space.
24. Cont’d
•
If a commercially available device or a large intravenous catheter is
being used, the skin should be nicked with a No. 11 scalpel blade to
reduce drag as the catheter is advanced through the skin.
25. Cont’d
• With either a syringe pump or a vacuum bottle, the pleural effusion
is drained until the desired volume has been removed for
symptomatic relief or diagnostic analysis.
26. Cont’d
• Approximately 30 to 75 mL of pleural fluid should be
withdrawn for analysis, and then the needle removed.
• A "dry" thoracentesis may result from
Absence of pleural fluid,
Incorrect needle placement,
Thick pleural fluid,
Use of an inappropriately short needle
27. Cont’d
o Aspiration of air implies that the lung has been punctured because
the needle was inserted superior to the effusion or too deeply
o
Aspiration of a small amount of blood suggests that the needle
may have been inserted inferior to the effusion (ie,
subdiaphragmatically)
o Failure to aspirate anything implies that the needle may have
been too short to penetrate the pleura, especially in an obese
patient.