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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.
PURPOSE
To 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
INDICATION
Traumatic pneumothorax
Hemopneumothorax
Spontaneous pneumothorax
Bronchopleural fistula
Pleural effusion
CONTRAINDICATION
An uncooperative patient
Coagulation disorder
Atelectasis
Only one functioning lung
Emphysema(pulmonary enlargement)
Severe cough or hiccups
COMPLICATION
Pulmonary edema
Bleeding
Respiratory distress
Infection
Air embolism
Dyspnea and
Cardiac tamponade(fluid
build up in the space
between myocardium and
pericardium)
cough
Atelectasis(lung
collapes)
BEFORE THE PROCEDURE
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
CONT
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
Prepare Equipment
Dressing set
Abrahams 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
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
R: To prevent complication such as
bleeding while during procedure.
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.
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
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.
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.
AFTER PROCEDURE
Document the procedure, patients 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.
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
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.
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