Thoracentesis

Question 1

Thoracentesis

Answer 1

-A thoracentesis is a diagnostic and or therapeutic procedure in which a needle is inserted into the chest to remove air/ fluid from the pleural space

-The most common pleural disorder that requires a thoracentesis is a pleural effusion

Question 2

-The presence of pleural effusion may be established by

Answer 2

-X ray findings lateral decubitus(xray on the side) film shows concave upper border ir a continual line from the diaphragm to apices

	-Physical examination reveals flatness to percussion and diminished breath sounds and tracheal shift away from the site

	-Ultrasound Techniques

Question 3

Thoracentesis

-Indications

Answer 3

-Pleural effusion which needs diagnostic work up

-Symptomatic treatment of large pleural effusion

-Diagnostic thoracentesis may be performed to identify the cause of pleural effusion

-The analysis of the pleural fluid is extremely useful in the diagnosis and staging of suspected or known malignancy

Question 4

Therapeutic thoracentesis

Answer 4

-Therapeutic thoracentesis may be performed to relieve shortness of breath or pain caused by a large pleural effusion, to remove air trapped between the lung and chest wall, or to administer medication directly into the lung cavity to treat the cause of fluid accumulation or to treat the malignancy

Question 5

Thoracentesis

-Procedure

Answer 5

-The most common position for the procedure is to have the PT sitting up and leaning forward, typically over a bedside table

	-3-10 ML of 2% lidocaine hydrochloride is used to anesthetize the thickness of the chest wall

	-A longer and larger needle is then used to anesthetize the thickness of the chest wall

	-The needle is inserted through the 7th or 8th intercostal space at the site of maximal dullness

	-The needle is inserted until the fluid level is reached. This is established when fluid can be withdrawn

	-100-300 ml of pleural fluid is aspirated for diagnostic purposes with a 50 ml syringe

Question 6

-After the thoracentesis is complete

Answer 6

-After the thoracentesis is complete, the needle is withdrawn and the puncture hole is pinched between the fingers to prevent air entry. The puncture hole may be sutured closed or closed with adhesive tape. The PT is usually instructed to lie on the puncture site for about an hour to allow the puncture site to seal.

Question 7

-Analysis of pleural fluid

Answer 7

-Transudate fluid is usually clear and has a light straw color

	-A transudate (clear) fluid is also called serous fluid, CHF most common

	-This type of fluid would be associated with congestive heart failure. As more cells are added to the fluid, the fluid tends to get cloudy or what is called opaque

	-Empyema has an opaque appearance and is called an exudate fluid

	-Infections would produce yellow or milky exudate fluid

	-Body effusion (hemothorax, serosanguineous may suggest malignancy or cancer

	-Purulent, pus filled exudate

	-Mucopurulent, containing mucus and pus exudate

	-Chyle (milky) containing lymphocytic exudative fluid

	-Loculated, very thick walled in a pocket

	-Pleural fluid PH can be measured, a PH less than 7.30 is considered significant (exudate)

Question 8

Thoracentesis Complications

Answer 8

-A CXR is generally obtained shortly after the procedure to ensure that no complications have developed

-Complications

	-Pneumothorax

   -post-aspiration pulmonary edema

 	-Infection

    -Bleeding

	-Organ damage