THORACENTESIS

Thoracentesis
Is the aspiration of fluid or air from the pleural space. It may be a diagnostic or a therapeutic procedure.

Purposes:
a) To remove fluid and air from the pleural cavity(for diagnostic and therapeutic purposes) b) To obtain diagnostic aspiration of pleural fluid. c) To obtain pleural biopsy.t d) To install medication into the pleural space.

Equipments:
            Syringes:5,20,50 ml syringes Needles: no.22, no.26, no.16(7.5cm long) Stopcock and tubing Hemostat Biopsy needle Germicide solution sterile gloves Local anesthetic Sterile gauze dressings Sterile towels and drape Sterile specimen container or for ultz-directed thoracentesis: needle-syringe assembly (needle, extension tubing, syringe)

Procedures: Preparatory phase Ascertain in advance if chest roentgenograms and /or other tests have been prescribed and completed. These should be available at the bedside. See if consent form has been explained and signed. Determined if the pt. is allergic to the local anesthetic agent to be used. Give sedation if prescribe.

In form the pt. aboout the procedureand indicate howhe can be heplful. Explain:  The nature of the procedure.  The importance of remaining immobile.  Pressure sensation will be experienced.  That no comfort will be anticipated after the procedure. Make the pt. comfortable with adequate supports. If possible place him up right and in one of the following position.  Sitting on the edge of the bed with feet supported and head on the padded over the bed table.  Straddling a chair with his arms and head resting on the back of the chair.  If pt. is unable to sit on a chair or side of bed elevate head 30-40 degree or place him on unaffected side and elevate head of bed.

Support and reasure the pt. during the procedure:  Prepare the pt. for sensations of cold from skin germicide and for pressure and sting from infiltration of local anesthetic agent.  Encourage the pt. to refrain from coughing.

Peformance phase
the site ofor aspiration is determined from chest x-rays, by percussion, or by fluoroscopic or ultrasound localization. if fluid is in the pleural cavity, the thoracentesis site is determined by study of the chest x-ray and physical findings, with attention to the site of maximal dullness on percussion. The procedure is done under aseptic conditions. After the skin is cleansed, the physician injects a local anesthetic with a small caliber needle into the intercostal space.

the physician advances the thoracentesis needle with the syringe attached. When pleural space is reached, suction maybe applied with the syringe.  A 20 ml, or 50ml, syringe with a three way adapter(stop cock)is attached to the needle.(one end of the adapter is attached to the needle and other to the tubing leading to a receptacle that receives the fluid being aspirated.)  If a considerable quantity of fluid to be removed, the needle is held in place on the chest wall with the small hemostat.  A pleural biopsy may be performed. After the needle is being withdrawn, pressure is applied over the puncture site and a small sterile dressing is fixed in place.

Follow up phase
place the pt. on bed rest. A chest x-ray is usually obtained following thoracentesis.

Record V/S every 15 mins. For 1 hr. Administer oxygen as directed if pt. has cardiorespiratory disease. Record the total amount of fluid withdrawn and the nature of the fluid, its color and viscosity. If prescribed, prepare samples of fluid for laboratory evaluation(usually bacteriology, cell count and differential, determination of protein, glucose, LDH, specific gravity). A small amount of heparin may be needed for several of the specimen containers to prevent coagulation. A specimen container with preservative may be needed if a pleural biopsy is to be obtained. Evaluate the pt. at intervals for increasing respirations, faintness, vertigo, tightness in the chest, uncontrollable cough, blood-tinged frothy mucus, and rapid pulse and signs of hypoxemia.