Thoracentesis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Shaik Aisha sultana, [3]
Overview
Thoracentesis (also known as thoracocentesis or pleural tap) is an invasive procedure to remove fluid or air from the pleural space for diagnostic or therapeutic purposes. A cannula, or hollow needle, is carefully introduced into the thorax, generally after administration of local anesthesia. The procedure was first described in 1852.
Procedure
- Thoracocentesis can be performed by carefully inserting a needle into the pleural space, in order to aspirate the pathologically collected fluid or air and allow the compressed lung to re-inflate.
- Ultrasound guided needle aspiration is a very useful technique
- Ultrasound guided aspiration should be performed in order to reduce complications.
Steps
- First, confirm the extent of the pleural effusion or pneumothorax by chest percussion and consider an imaging study, bedside ultrasonography is recommended to reduce the risk of pneumothorax, hemothorax and to get the successful tap.[1]
- Needle is inserted in the mid-scapular line at the upper border of the rib one intercostal space below the top of the effusion.
- Insertion point is marked with a skin marker, and prepare the area with a skin cleansing agent such as chlorhexidine.
- Apply a sterile drape while wearing sterile gloves.
- A sterile needle is used and local anesthetic is injected subcutaneously, and wheal is raised at the point marked. Slowly advance the needle deeper and inject anesthetic until reaching the parietal pleura, Infiltarte the parietal pleura as it is very sensitive. continue to advance the needle until pleural fluid is aspirated. Note the depth at which fluid is aspirated.
- Now, take a large-bore (16- to 19-gauge) thoracentesis needle-catheter device and attach it to a 3-way stopcock, place a 30- to 50-mL syringe on one port of the stopcock and attach drainage tubing to the other port.
- Insert this needle along the upper border of the rib while aspirating and advance it into the effusion.
- When large amount of pleural fluid has to b aspirated, insert the catheter over the needle into the pleural space and withdraw the needle, leaving the catheter in the pleural space.
- While preparing to insert the catheter, cover the needle opening during inspiration to prevent entry of air into the pleural space.
- Withdraw 30 ml of fluid into the syringe and place the fluid in appropriate tubes and send for testing.
- If a larger amount of fluid is to be drained, turn the stopcock and allow fluid to drain into a collection bag. Alternatively, aspirate fluid using the syringe, taking care to regularly release pressure on the plunger.
- After the tapping is done, remove the catheter while patient is holding his breath or expiring. Apply a sterile dressing to the insertion site.
Shown below is a video demonstrating the step wise procedure of thoracentesis.
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References
- ↑ Barnes, Terrance W.; Morgenthaler, Timothy I.; Olson, Eric J.; Hesley, Gina K.; Decker, Paul A.; Ryu, Jay H. (2005). "Sonographically guided thoracentesis and rate of pneumothorax". Journal of Clinical Ultrasound. 33 (9): 442–446. doi:10.1002/jcu.20163. ISSN 0091-2751.