thoracocentesis


Also found in: Dictionary, Thesaurus, Wikipedia.
Related to thoracocentesis: Chest tube

thoracentesis

 [thor″ah-sen-te´sis]
surgical puncture and drainage of the thoracic cavity; it may be done as an aid to the diagnosis of inflammatory or neoplastic diseases of the lung or pleura, or it may be used as a therapeutic measure to remove accumulations of fluid from the thoracic cavity. Called also pleurocentesis.



The procedure is done with the patient sitting up, the arms and head resting on the overbed table or over the back of a chair which the patient straddles. If unable to sit up, the patient is turned onto the unaffected side. The skin at the site of insertion of the needle is cleansed with an antiseptic, and a local anesthetic is injected. The site most often used is the seventh intercostal space, just below the angle of the scapula.

After the procedure is completed the wound usually is sealed with collodion and covered with a sterile dressing. Then a chest x-ray should be done to detect any pneumothorax. The site is checked frequently for signs of leakage. The total amount and character of the fluid obtained is noted on the patient's chart. Samples of fluid are sent to the laboratory for evaluation if requested. Immediately following the thoracentesis the patient is positioned on the unaffected side to rest the site of insertion of the trocar and allow it to seal itself. The patient is observed for signs of dizziness, changes in skin color, and respiratory and heart rate changes. Other signs of complications following thoracentesis include excessive coughing, blood-tinged sputum, and tightness of the chest.

Possible aftereffects of the procedure include pneumothorax, subcutaneous emphysema (accumulation of air in the tissues of the skin), and bacterial infection. A mediastinal shift resulting from removal of large amounts of fluid from the thoracic cavity may produce cardiac distress and pulmonary edema.
Technique of thoracentesis. The needle is advanced only as far as the pleural space.

tho·ra·cen·te·sis

(thō'ră-sen-tē'sis),
Paracentesis of the pleural cavity.
[thoraco- + G. kentēsis, puncture]

tho·ra·cen·te·sis

(thōr'ă-sen-tē'sis)
Paracentesis of the pleural cavity.
Synonym(s): pleural tap, pleurocentesis, thoracocentesis.
[thoraco- + G. kentēsis, puncture]

thoracentesis

, thoracocentesis (tho?ra-sen-te'sis ) (?ra-ko-) [ thoraco- + centesis]
Enlarge picture
THORACENTESIS
Insertion of a needle through the chest wall and into the pleural space, usually to remove fluid for diagnostic or therapeutic purposes. Synonym: pleurocentesis; thoracocentesis See: illustration

Patient care

Before the procedure, the patient is carefully examined, a history is taken, and radiological studies, such as chest x-rays or ultrasonograms, are reviewed. The procedure should be explained to the patient and sensation information provided (stinging with anesthesia instillation). The risks (bleeding, puncture of the lung with subsequent lung collapse, or introduction of infection), as well as the benefits and alternatives to the procedure, should be carefully reviewed. If the patient wishes to proceed, a consent form with the patient's signature must be completed. Allergies to local anesthetics are noted. Baseline vital signs will be obtained and supplemental oxygen administered. Cardiac monitoring is usually performed. A nurse or respiratory therapist may assist the physician and support the patient throughout the procedure. Equipment is assembled for the procedure, and, in most instances, the fluid is identified with ultrasound to avoid injury to the liver, lung, or other tissues. The patient is positioned to make pleural fluid accessible to the examiner.

The patient's skin is prepared per protocol, the area is draped, and local anesthesia is injected subcutaneously. After allowing a short time for this to become effective, the thoracentesis needle is inserted above the rib to avoid damaging intercostal vessels, which run in a neurovascular bundle beneath each rib. The patient is advised not to move, cough, or take a deep breath during the procedure to reduce the risk of injury. When the needle contacts the fluid pocket, fluid can be withdrawn by gravity drainage or with suction. When indicated after removal of the thoracentesis needle or cannula, a larger bore thoracostomy tube may be inserted to provide additional drainage.

During thoracentesis, health care professionals should assess the patient for difficulty in breathing, dizziness, faintness, chest pain, nausea, pallor or cyanosis, weakness, sweating, cough, alterations in vital signs, oxygen saturation levels, or cardiac rhythm. An occlusive dressing should be applied to the puncture site as the needle or cannula is removed, preventing air entry. The fluid obtained is labeled and sent for diagnostic tests as ordered (typically Gram stain, cultures, cell count, measurements of fluid chemistries, pH, and, when appropriate, cytology). The amount, color, and character of the fluid is documented, along with the time of the procedure, the exact location of the puncture, and the patient's reaction. After the procedure, a chest x-ray is often obtained to assess results or determine if any injury has occurred, e.g., pneumothorax. The patient should be positioned comfortably. Vital signs are monitored until stable, then as needed. The patient is advised to call for assistance immediately, if difficulty in breathing or pleuritic pain is experienced.

References in periodicals archive ?
Our patient improved with right-sided thoracocentesis without the need for pericardiocentesis.
[16] BPF was diagnosed if chest x-ray prior to thoracocentesis revealed horizontal air fluid level in the upright position and air leak through the tube thoracostomy persisted for more than 24 hours after tube thoracostomy.
Thoracocentesis is useful in confirmation of diaphragmatic hernia and can be used for field level (Misk, 2015).
Technically, this procedure is relatively simple, well tolerated and quite safe; however complications related to thoracocentesis are not uncommon2.
[sup][2] If the patient presents in acute respiratory distress with massive pleural effusion, thoracocentesis or pleural catheter placement or mechanical ventilation should be performed first.
Nurses must be familiar with the Potain aspirator to know how to clean it, assemble it, make it function to help the physician during the thoracocentesis operation (LM 7:196.
Thoracocentesis and surgical drainage were performed; pleural fluid was obtained for culture.
(4,8) A correct diagnosis should be arrived at expeditiously, as unnecessary thoracocentesis and other procedures have been done.
As this was a retrospective study and patient consent had been obtained prior to thoracocentesis, the need for individual patient consent for this study was waived by the ethics committee.
(1), (6) The initial thoracocentesis is often done for diagnostic purposes, except when the patient complains of shortness of breath at rest, where it could also be done for therapeutic benefit.
Repeated thoracocentesis revealed straw-coloured fluid with protein >3 g/dl, and inflammatory cells with a lymphocytic predominance without any atypical cells.
Thoracocentesis was performed and obtaining fluid (pleural effusions and frank empyema fluid identified by obliteration of costophrenic angles on chest x-ray) from the pleural space was tested for gram stain and culture to isolate pneumonic infection by biochemical analysis.