thoracentesis

Definition:

     Assisting in introducing a hollow needle into pleural cavity and aspirating fluid or air, using aseptic technique.

Purpose:

·         To drain fluid/air from pleural cavity for diagnostic or therapeutic purpose

·         To introduce medications

·         To aid in full expansion of lung

·         To obtain specimen for biopsy

Equipment:

1.      Dressing trolley

2.      Chest aspiration set which containing a tray with:

a.       Artery clamps (2)

b.      Pint measure (1)

c.       Dressing cups (2)

d.      3-way stop cock (Metal) (3)

e.       Rubber tube with metal weight (1)

f.       K-basin (1)

g.      Surgical towels (4)

h.      Sponge holder (1)

i.        Cotton balls and gauze pieces

j.        Abraham’s needle

k.      Scalpel blade 3/11 (if pleural biopsy is to be done)

3.      Cardiac table with 2 pillows

4.      Injection tray with:

a.       Antiseptic solutions (Betadine iodine, iodine and spirit)

b.      Lignocaine 2%

c.       Tincture benzoin

d.      20cc syringe (1)

e.       5cc syringe (1)

f.       20G needle (1)

g.      22G needle (1)

5.      Aspiration needle (1)

6.      Gloves

7.      Mask

8.      Mackintosh

9.      Specimen containers

10.  Adhesive and scissors

1.	Explain procedure to patient and relatives
2.	Provide privacy
3.	Collect all equipment on dressing trolley and keep them ready at bedside. Collect the recent chest X-ray.
4.	Protect bed with mackintosh
5.	Position the patient in Fowler’s. Bring the patient to one side of bed with feet supported, arms and head leaning forward on a cardiac table with pillows
6.	Untie gown and expose the site for aspiration
7.	Instruct the patient to avoid coughing and to remain immobile during procedure
8.	Explain that a feeling of deep pressure will be experienced while fluid is being aspirated from pleural space
9.	Provide sterile gloves to doctor
10.	Open sterile set and slide 20cc, 5cc syringes, 20 and 22G needles, and aspiration needle into the tray
11.	Pour antiseptic solution in the cup to clean site
12.	After showing label to the doctor, clean the top of local  anaesthetic bottle and assist to withdraw medication
13.	Reassure the patient and instruct him/her to hold breath during insertion of aspiration needle
14.	Assess for increasing respiratory rate, diaphoresis, rapid pulse, cyanosis, complaints of chest pain, chest tightness, uncontrollable cough and blood tinged, frothy sputum, while the physician do the procedure
15.	Inform doctor, if any untoward reactions are observed, who may halt the procedure temporarily
16.	After fluid is withdrawn from pleural space, transfer it to specimen containers
17.	After the needle is withdrawn, apply pressure over the puncture site
18.	Assist the patient in sealing  the site with tincture benzoin
19.	Make the patient comfortable
20.	Replace equipment
21.	Document the amount, colour and nature of the fluid collected and patient’s condition. Send the specimens to respective laboratory
22.	Instruct the patient to be on strict bed rest for 6-8 hours

Post-procedure care

1.	Instruct the patient to lie on the non-affected side for 1 hour
2.	Ensure bed rest for 6-8 hours
3.	Monitor vital signs every half an hour until the patient is stable
4.	Observe the patient for signs and symptoms of hemothorax, tension pneumothorax, subcutaneous emphysema and air embolism
5.	Assist in taking chest X-ray if indicated
6.	Administer analgesics and antibiotics as prescribed
7.	Instruct the patient to carry out deep breathing exercises