Thoracentesis Pro

THORACENTESIS
Thoracentesis, also known as a pleural

tap, is a procedure done when there’s too
much fluid in the pleural space. This allows a
pleural fluid analysis to be performed in the
lab to figure out the cause of fluid
accumulation around one or both of the
lungs. The pleural space is the small space
between the lungs and the chest wall. This
space typically contains approximately 4
teaspoons of fluid. Some conditions can cause more fluid to enter this space. These
conditions include:
 cancer tumors
 pneumonia or other lung infection
 congestive heart failure
 chronic lung diseases
This is called pleural effusion. If there’s excess fluid, it can compress the lungs and cause
difficulty breathing.
The goal of a thoracentesis is to drain the fluid and make it easier for the patient to breathe
again. In some cases, the procedure will also help doctors in discovering the cause of the
pleural effusion.
The amount of fluid drained varies depending on the reasons for performing the
procedure. It typically takes 10 to 15 minutes, but it can take longer if there’s a lot of fluid
in the pleural space.
Doctor may also perform a pleural biopsy at the same time, to get a piece of tissue from
the lining of the inner chest wall. Abnormal results on a pleural biopsy can indicate certain
causes for the effusion, including:
 the presence of cancer cells, such as lung cancer
 mesothelioma, which is an asbestos-related cancer of the tissues that cover the

lungs
 collagen vascular disease
 viral or fungal diseases
 parasitic disease
Pleural Fluid Culture »
Preparation
Preparing for a thoracentesis
There’s no special preparation for a thoracentesis. However, the patient should talk to her
doctor if she has any questions or concerns about the procedure. She should also tell
yher doctor if she:
 is currently taking medications, including blood thinners like aspirin, clopidogrel

(Plavix), or warfarin (Coumadin)
 is allergic to any medications
 has any bleeding problems
 may be pregnant
 has lung scarring from previous procedures
 currently have any lung diseases like lung cancer or emphysema
Procedure
What is the procedure for a thoracentesis?

Thoracentesis can be done in a doctor’s office or in a hospital. It’s typically done while the
patient is awake, but she may be sedated. The patient will need someone else to drive
her home after the procedure if she’s sedated.
After sitting in a chair or lying on a table, the patient will be positioned in a way that allows
the doctor to access the pleural space. An ultrasound may be done to ascertain the
correct area where the needle will go. The selected area will be cleaned and injected with
a numbing agent.
The doctor will insert the needle or tube below the ribs into the pleural space. The patient
might feel an uncomfortable pressure during this process, but she should be very still.
The excess fluid will then be drained out.
Once all the fluid is drained, a bandage will be put on the insertion site. To ensure there
are no complications, the patient may be asked to stay overnight in the hospital to be
monitored. A follow-up X-ray may be performed right after the thoracentesis.
Risks
What are the risks of the procedure?
Every invasive procedure has risks, but side effects are uncommon with thoracentesis.
Possible risks include:
 pain
 bleeding
 air accumulation (pneumothorax) pushing on the lung causing a collapsed lung
 infection
The doctor will go over the risks before the procedure.
Thoracentesis is not an appropriate procedure for everyone. Doctor will determine if the
patient is a good candidate for thoracentesis. People who’ve had recent lung surgery may
have scarring, which can make the procedure difficult.
People who should not undergo thoracentesis include people:
 with a bleeding disorder
 taking blood thinners
 with heart failure or enlargement of the heart with trapped lung
Follow-up
Following up after the procedure
After the procedure is over, patient’s vitals will be monitored, and may have an X-ray of
her lungs taken. The doctor will allow the patient to go home if her breathing rate, oxygen
saturation, blood pressure, and pulse are all good. Most people who have a thoracentesis
can go home the same day.
Patient will be able to return to most of her normal activities soon after the procedure.
However, the doctor may recommend her to avoid physical activity for several days after
the procedure.
The doctor will explain how to take care of the puncture site. Make sure to call your doctor
if you begin to have any signs of infection. Symptoms of infection include:
 trouble breathing
 coughing up blood
 fever or chills
 pain when you take deep breaths
 redness, pain, or bleeding around the needle site

NURSING RESPONSIBILITIES
Pre-operative
 Assist the patient to prepare emotionally and psychologically for the procedure by
describing the procedure, expectations after the surgery, and answering any
questions regarding the procedure. Review the patient’s medical history: check for
any possible allergies to medications.
 Monitor and record vital signs for baseline data

 Ensure that the patient has signed a consent form necessary for the operation.
 Prepare for all needed materials for the procedure..
 Document the time the patient leaves the room for the operation.
Intra-operative
 Place the patient in a position appropriate for the procedure to allow optimum
exposure of the operative site, access for the anesthetist, access for the nurse to
take vital signs and monitor IV infusions, safety of the patient by preventing injuries
and maintaining circulation, and maintenance of the patient’s dignity and modesty.
 Prepare the skin with an antiseptic in the incision site and drape the patient
immediately after the area is prepared to avoid contamination.
 Document findings and the surgical counts on the patient’s records.
Post-operative
 Place the patient in the recovery position as indicated.

 Monitor the patient’s vital signs as indicated.
 Ensure a clear airway and adequate ventilation.
 Administer post-operative medications and contraptions, as indicated.
 Note for abnormalities in the site such as bleeding.
 Check the dressings frequently for any abnormal drainage and notify the physician
if abnormality notice.

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THORACENTESIS

Thoracentesis, also known as a pleural

 pneumonia or other lung infection

 congestive heart failure

 chronic lung diseases

 mesothelioma, which is an asbestos-related cancer of the tissues that cover the

 collagen vascular disease

 viral or fungal diseases

Pleural Fluid Culture »

Preparing for a thoracentesis

 is currently taking medications, including blood thinners like aspirin, clopidogrel

 is allergic to any medications

 has any bleeding problems

 has lung scarring from previous procedures

 currently have any lung diseases like lung cancer or emphysema

What is the procedure for a thoracentesis?

What are the risks of the procedure?

 air accumulation (pneumothorax) pushing on the lung causing a collapsed lung

People who should not undergo thoracentesis include people:

 with a bleeding disorder

 taking blood thinners

 with heart failure or enlargement of the heart with trapped lung

Following up after the procedure

 pain when you take deep breaths

 redness, pain, or bleeding around the needle site

any possible allergies to medications.

 Monitor and record vital signs for baseline data

immediately after the area is prepared to avoid contamination.

 Document findings and the surgical counts on the patient’s records.

 Place the patient in the recovery position as indicated.

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