Thoracentesis is a procedure to drain excess fluid from the pleural space between the lungs and chest wall. It involves inserting a needle through the chest wall under local anesthesia to remove fluid for analysis or to relieve symptoms like shortness of breath. Precautions are taken before and during the procedure to monitor vital signs and breathing. After the procedure, the patient is observed for complications and a chest x-ray may be taken to evaluate the drainage.

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2. 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.

3. 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

4. INDICATION
Traumatic pneumothorax
Hemopneumothorax
Spontaneous pneumothorax
Bronchopleural fistula
Pleural effusion

5. CONTRAINDICATION
An uncooperative patient
Coagulation disorder
Atelectasis
Only one functioning lung
Emphysema(pulmonary enlargement)
Severe cough or hiccups

6. COMPLICATION
 Pulmonary edema  Bleeding
 Respiratory distress  Infection
 Air embolism  Dyspnea and
cough
 Cardiac tamponade(fluid
build up in the space  Atelectasis(lung
between myocardium and collapes)
pericardium)

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8. 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

9. CON’T…
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
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10. • Prepare Equipment
 Dressing set  Povidone / Alcohol
 Abraham’s needle  Local anaesthetic, e.g.
lignocaine (lidocaine) 1%
 Connecting tubing or 2%
 Syringe 50ml and 5ml  Formalin bottle
 Scapel blade and blade 11  Urine bottle x2
 Needles (18 and 23  C+S bottle
gauge)  3-way stopcock
 Sterile Glove
 Fenestrated towel
 Mask
 Jug

11. 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.

12. 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.

14. 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

15. 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.

16. 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.

17. AFTER PROCEDURE
Document the procedure, patient’s 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.

18. 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

19. 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.

20. THANK YOU !!!