Thoracentesis is a medical procedure that involves inserting a needle into the pleural space to remove fluid or air, decrease lung pressure, conduct diagnostic studies, or deliver medication. The procedure requires informed consent, patient preparation, and careful monitoring of vital signs, aiming to remove 1000-2000ml for therapeutic purposes or 30-60ml for diagnostic purposes. Post-procedure care includes monitoring for complications and instructing the patient on breathing exercises.

1. THORACENTESIS

2. Definition
Insertion Of A Needle Into A
Pleural Space To Remove Accumulation Of
Fluid And Aseptic Technique

3. Purposes Of the Procedure
To remove the air and fluid from pleural cavity
To decrease pressure on the lung tissue
To aspirate pleural fluid for diagnostic studies
To instill the medication in the pleural space
To perform pleural biopsy

4. I. A pleural aspiration set containing

5. 1. Sponge Holding Forceps

6. 2. Syringe (5ml) & Needle

7. 3. Syringe (20ml) & Leur
Lock

8. 4.Aspiration Needle (16G)

9. 5. Small Bowl(2)

10. 6.Dissecting Forceps(1)

11. 7.Artery Forceps(1)

12. 8. Specimen Bottles And
Slides

13. 9.Gown Mask Glove

14. 10. Sterile Dressing Towels

15. 11. Cotton Swab Gauze
Pieces & Pads

16. 12. Scalpel Blade

17. II. Clean Tray Containing

18. 1. Mackintosh & Towel

19. 2.Kidney Tray

20. 3.Paper Bag

21. 4.Spirit

22. 5.Iodine

23. 6.Lignocaine 2%

24. 7. Adhesive Plaster

25. 8.Tincture Benzoic

26. III. Other article like

27. 1.Cardiac Table

28. 2. Pillows

29. Procedure of thoracentesis
1. Identify Patient And Explain Procedure To
Him And Relatives. Explain That Procedure He
May Experience A Sensation Of Deep
Pressure When Fluid Is Aspirated
2. Review The Chest X-ray
3. Obtained An Informed Consent From Patient
4. Instruct The Patient The He Should Not Move
During The Procedure

30. 5. Position The Patient Comfortably
A. Sitting On The Edge Of Bed With Full
Supported, Arms And Head On Pillow Over The
Cardiac Table
B. Straddling A Chair With Arms And Head
Resting On The Back Of Chair
C. Lying On The Unaffected Side With The
Bed Elevated 30-40 Degree If Patient Is Unable
To Assume Sitting Position

31. 6. Expose The Chest. The Physician Determines
The Sites For Aspiration By Visualizing Chest X-
ray Performing Chest Percussion. If Air Is To Be
Removed The Site Is Usually In 2nd And 3rd
Intercostals Space. If Fluid Is To Be Aspirated
Then Usually The Site In The 8th And 9th
Intercostals Space
7. Clean The Site With Antiseptic Solution And
Assist For Administering The Local Anesthesia
8. The Physician Introduces The Thoracentesis
Needle. Instruct The Patient To Hold His Breath
When Needle Is Inserted.

32. 9. When Needle Is In Pleural Space Physician
Aspirates Pleural Fluid With Syringes. Assisting
In Collecting Specimen In Sterile Container
- A 20ml Syringes With 3-way Adapter Is
Attached To Needle. The Tubing Which Leads
To The Recitals Is Attached To Third Port Of
Three-way Adapter.
- If Consider Quantity Of Fluid Is To Be
Removed The Needle Is Held In Place On The
Chest Wall With A Small Hemostat

33. 10. For Therapeutic Purposes Usually 1000-
2000ml Of Fluid Is Removed And For
Diagnostic Purpose30-60ml Of Fluid Is
Removed. Encourage The Patient To Remain
Still During The Procedure And Monitor The
Vital Sign.
11. After Needle Is Withdrawn, Apply The
Tincture Benzoic Seal And Pressure Dressing
Over The Site.
12. Position The Patient In The Bed With
Affected Side Up. He Should Remain In Bed For
4-6 Hours After Procedure.

34. 13. Monitor The Vital Sign For Every 4-6 Hours Or
Still Steady. Observe Patient For Complication
Such As Shock, Fainting, Low Blood Pressure,
Low Pulse Rate And Respiratory Rate,
Uncontrolled Cough Etc. Check Breathing Sound
In All Lung Fields.
14.Record The Procedure With Total Amount Of
Fluid Withdrawn, Color, Nature And Signs Of
Complication.
15. Send Labelled Specimen To Library.

35. 16. Instruct The Patient For Deep Breathing And
Coughing Exercise. Demonstrate And Teach
These Exercise To Patient
17.Have A Chest X-ray If Indicated
18. Wash The Articles Used For Thoracentesis In
Cold Water And Then In Warm Soapy Water
Rinse, Dry And Send For Autoclaving, Wear
Gloves While Washing

36. Summary
So Far In this clinical teaching we have explain
about:-
 Definition
 Purposes
 Articles
 Procedure