Thoracentesis procedure in Nursing Care for patient

Thoracentesis procedure in Nursing Care for patient

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  THORACENTESIS Dr. Peter JasperYoutham Professor/HOD, Medical Surgical Nursing Amaltas University
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  Introduction Thoracentesis is alsoknown 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.
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  Definition Thoracentesis is theinsertion of Needle into the pleural space through the chest wall to remove the pleural fluid or possibly air.
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  Purpose ◦ To removeexcess pleural fluid ◦ To drain fluid/air from pleural cavity for diagnostic air therapeutic purpose ◦ To provide medication ◦ To obtain specimen for biopsy ◦ To take pleural biopsy for examination ◦ To relieve pain ◦ To relieve breathlessness
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  Indication ◦ Traumatic pneumothorax ◦Hemopneumothorax ◦ Spontaneous pneumothorax ◦ Broncho pleural fistula ◦ Pleural effusion ◦ Diagnostic Purpose ◦ Therapeutic Purpose
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  Contra Indications ◦ Coagulationdisorder ◦ Skin infection ◦ Atelectasis ◦ Only one lung functioning ◦ Emphysema ◦ Sever cough ◦ Uncooperative patient
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  Preparation of Patient ◦Explain the procedure to the patient ◦ Take a written consent from the patient. ◦ Perform diagnostic test like chest x-ray and ultrasound ◦ Check platelet count and presence of coagulopathy
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  Articles for theprocedure
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  Before the Procedure ◦Place patient in the upright position
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  Before the Procedure ◦Explain to the patient that he/she will receive a local anaesthesia ◦ Clean patient skin with antiseptic solution
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  Procedure ◦ Position patientupright and sitting with arms up and forward (draping arms over a bedside table is perfect). ◦ Select site for needle puncture. This should be done clinically, by percussion of the chest wall, to locate the upper end of the effusion. Measure down two rib interspaces from this upper end of the effusion in the mid-scapular line. Mark this space with a pen or fingernail; this will be the needle puncture site.
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  Procedure ◦ Cleanse skinover puncture site with skin prep and drape to create a sterile field. ◦ Anesthetize the skin and deeper layers with the lidocaine. Be sure to anesthetize the pleura, which is quite pain-sensitive. ◦ Remove thoracentesis or blood tubing from its packaging, and close the midpoint clamp securely. Attach the 18-gauge needle to the free end of the tubing. ◦ Remove the protective covering from the evacuated bottle stopper. Insert the tubing with the fixed needle through the stopper.
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  ◦ With thefree 18-gauge needle, puncture the skin at the marked intercostal space. ◦ Open the clamp. This will provide negative pressure from the evacuated bottle. ◦ If frank blood returns, you may have punctured the lung. Withdraw needle slowly until fluid flows. If no fluid flows at all, with draw the needle until it is just under the skin. Clamp the tubing, and with draw the needle completely from the patient. ◦ Close clamp on collection tubing. Leave intercostal needle in place. Remove needle from the full collection bottle, and replace it into the new empty collection bottle. Then, re-open clamp.
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  ◦ When procedureis done , Leave tubing clamp OPEN. Remove intercostal needle slowly and completely from patient. Dress puncture site with an occlusive dressing. ◦ Obtain a post-procedure radiograph to check for pneumothorax
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  Position for Thoracentesis
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  Procedure
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  Post Procedure Care ◦Monitor pulse, color, oxygen saturation, and other signs during thoracentesis. ◦ Apply a dressing over the puncture site, and position on the unaffected side for 1 hour. This allows the pleural puncture to heal. ◦ Label obtained specimen with name, date, source, and diagnosis; send specimen to the laboratory for analysis. Fluid obtained during thoracentesis may be examined for abnormal cells, bacteria, and other substances to determine the cause of the pleural effusion. ◦ During the first several hours after thoracentesis, frequently assess and document vital signs; oxygen saturation; respiratory status, including, respiratory excursion, lung sounds, cough, or hemoptysis; and puncture site for bleeding
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  Complications ◦ Pneumothorax andHaemothorax ◦ Tension Pneumothorax ◦ Mediastinal shift ◦ Pulmonary Edema