Thoracentesis is the aspiration of fluid from the chest or pleural cavity. It is done for therapeutic and diagnostic purposes. It is therapeutic for patients with hydrothorax when absorption of fluid fails, also for patients with dyspnea and pain resulting from accumulation of fluids and lastly to introduce medications.
The puncture site for thoracentesis is usually the 6th and 7th interspace in line with the axilla or the 7th or 8th interspace near the angle of the scapula.
Two positions may be used for patients who will undergo thoracentesis. (1) Lying on the unaffected side in a semi recumbent position near the edge of the bed, Place the arm of the affected side on the opposite shoulder and have the patient lean forward. To avoid strain, place pillows under the patient. (2) Sitting up in bed and leaning forward on bedside or over the bed table. Place hand of affected side on the opposite shoulder.
Materials to be used
1) Sterile tray
- 50 cc syringe
- 5 cc syringe
- Test tubes
- Needle; gauge 16 (2), 20, 22, 24
- Three way valve
- 10 inch rubber tubing
- Sterile gloves
- Kidney basin
- Rubber protector
- Sterile gauze
- Sterile towel
- Adhesive plaster
- Bandage scissors
- 50 cc Specimen bottle
2) Skin tray
- Povidone Iodine
- Cotton balls
- Pick up forceps
- Xylocaine 1-2%
1) Gather all necessary equipment. Place it within easy reach.
2) Explain the procedure to the patient. Secure a signed consent.
3) Position the client as mentioned above.
4) Expose the puncture site by removing the gown on the affected side. Put rubber protector below point.
5) Disinfect the area using benzene.
6) Paint the area with povidone iodine three time. Start from the center going outward in a circular motion.
7) Assist the physician with gloving and draping.
8) Assist the physician in the induction of anesthesia. The aspirating needle will then be inserted upon inspiration of the patient. The physician will then withdraw the fluid using 50cc syringe using a three way stopcock.
9)The aspirated fluid should be placed in a specimen bottle or a kidney basin.
10) Upon withdrawal of the needle, pressure should be applied for 15 to 30 minutes, and airtight sterile dressing should be applied on the puncture site.
11) Send specimen to the laboratory if required for analysis.
12) Document date and time of procedure, amount and characteristic of fluid withdrawn, and any abnormal conditions if applicable.
1) Stimulants may be given before the procedure.
2) Maintain strict aseptic technique throughout the procedure.
3) Coughing during the procedure indicates visceral pleaura has been pricked.
4) Place the patient on the affected side after the procedure.
5) An x-ray or CT scan may be necessary to check the location of the fluid.
6) Watch out for bloody sputum.
7) Instruct the patient to void before the procedure.
8) Watch out for the patient’s vital signs and general appearance because the operation includes a vital organ.