Thoracentesis

A. Definition of the Procedure:

Thoracentesis : the aspiration of fluid or air from the pleural space

B. Purposes of Procedure

a. to remove fluid and air from several cavity
b. to obtain diagnostic aspiration of pleural fluid
c. to obtain pleural biopsy
d. to install medication into the pleural space


C. Preparation of the Patient

1. Secure consent
2. Take initial vital signs
3. Prepare Abbocath gauge #16, 5 sterile specimen bottles, 1 liter sterile bottle, 50 cc syringe, 3 way stopcock, Lidocaine ampules
4. Position patient upright, leaning on overbed table
5. Instruct to remain still, avoid coughing during insertion of needles.
6. Pressure sensation is felt on insertion of needle.

D. Procedure

1. Maximum drainage : 1-1.5 liters x 24 hours
2. Usual site of insertion : 8th intercostal space posterior axillary line




E. Post-thoracentesis

Nursing Interventions:

> Turn on the unaffected side to prevent leakage of fluid into the thoracic cavity
> Bed rest
> Note for signs of respiratory distress and expectoration of blood
> Monitor vital signs

Doctor’s Orders
1. Repeat CXR (PA, Lateral) after thoracentesis
2. Serum Lactate Dhydrogenase (LDH) , Total Protein, Albumin, Globulin (TPAG), Glucose simultaneously.
3. Send specimen:
Bottle 1 : Cell count, Differential Count, Total Protein, LDH (5-10 mL EDTA)
Bottle 2 : AFB, Gram Stain, Culture and Sensitivity
Bottle 3 : Cytology and Cell Block (obtain 200 cc of fluid or more to increase yield)

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