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o Thoracentesis is a percutaneous procedure

during which a needle is inserted into the

pleural space and pleural fluid is removed

either through the needle or a catheter.

o ‘’Pleural tap’’ OR ‘’pleural fluid aspiration’’

Diagnostic• Pleural effusion

• Hemopneumothorax

• Empyema

Therapeutic• Large peural effusion

• Relieve the symptoms

Coagulation disorder

Active skin infection

Atelectasis

Only one functioning lung

Emphysema

Severe cough or hiccups

An uncooperative patient

Explain the purpose, risks/benefits, and steps of the procedure and obtain consent from the patient or appropriate legal design.

R: An explanation helps orient the patient to the procedure assist in coping and provide an opportunity to ask question and verbalise anxiety

Do Diagnostic Tests such as Chest X-ray Ultrasound

R: to determine the affected lung

Check platelet count and/or presence of coagulopathy

R: To prevent complication such as bleeding during procedure.

Dressing set

Abraham’s needle

Connecting tubing

Syringe

Needles (18 and 23 gauge)

Sterile Glove

Mask

Povidone / Alcohol

Local anaesthetic

Formalin bottle

Urine bottle x2

C+S bottle

3-way stopcock

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Place patient upright positionR: Ensures that the diaphragm is more dependent and facilitates the removal of fluid.

The lateral recumbent position if the patient is unable to sit upright.

BEFORE THE PROCEDURE

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Explain that he/she will receive a local anesthetic

R: to minimize pain during the procedure.

Clean patient skin with antiseptic

R: To prevent infection and maintain aseptic technique.

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Observe patient respiration rate and breathing pattern.

R: to provide base line data to estimate patient tolerance of procedure

Assess patient vital sign such as B/P, pulse

R: To prevent any complication such as hypovolemic shock during procedure.

Observe patient level of consciousness and give emotional support

R: To reduce patient anxiety

Monitor saturationR: To prevent hypoxia

Drain max 1.5 L in one sittingR: avoid re-expansion pulmonary edema

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Obtain a chest x-ray to evaluate the fluid level.R: To compare the conditions of the lungs before

and after the procedure. For specimen handling, fill the tubes with the

required amount of pleural fluidR : To prevent over intake of the fluid to the

specimen bottle. correct labelling of specimen bottle then send to

the labR: To prevent incorrect results to the patient.

Document the procedure, patient’s response, characteristics of fluid and amount, and patient response to follow-up.

R: To develop further treatment to the patient.

Provide post-procedural analgesics as needed. R: To prevent patient from pain related to the

incision site.

Rest in bed for about 2 hours after the procedureR: To minimize patient activity due to complication such as dyspnea.

Blood pressure and breathing will be checked for up to a few hoursR: to make sure don't have complications

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Pulmonary edema

Respiratory distress

Air embolism

Bleeding

Infection

Dyspnea and cough

Atelectasis

Pericardiocentesis

A therapeutic and diagnostic procedure in which fluid is removed from the pericardial space..

Cardiac Tamponade: It is an abnormal accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and subsequent hemodynamic compromise

Echocardiogram or ultrasound to identify Fluid quantity Coagulation Loculation

Discontinue anticoagulants

Informed consent

full facilities for resuscitation

Table for central line insertion with chlorhexidine for skin dressing pack sterile drapes local anesthetic (lidocaine 2%) syringes (including a 50 mL) needles (25G and 22G)

Pericardiocentesis needle (15 cm, 18G) Wallace cannula

Dilators (up to 7 French)

Pigtail catheter (60 cm with multiple side holes)

Drainage bag and connectors

Facilities for fluoroscopy or echocardiography

Position the patient at ~30°

Sedate lightly with midazolam

Wear sterile gown and gloves

clean the skin from mid-chest to mid-abdomen

sterile drapes on the patient

Identify the anatomic landmark Xiphoid process5th & 6th ribs

Select a site for needle insertion

Most commonly used sites Left sternocostal margin Subxiphoid approach..

Procedure

Infiltrate the skin and subcutaneous tissues with local anesthetic

Starting 1–1.5 cm below the xiphoid and left of midlineStaying close to the inferior border of the rib cartilages.

Insert the needle b/w xiphoid and left costal margin Angled at ~30°

Advance slowly, Aspirating & injecting lidocaineAiming for the left shoulder

Aspirate during insertion

stop advancing the needle Once fluid is encountered

continue aspirating

Reassess for improvement

repeated if necessary

Procedure

After the procedure Tube is left connected to drainage bottle

no more fluid drained no accumulation of fluid in the pericardium

Echocardiogram to monitor clearance of fluid.

Monitor blood pressurepulse neck veins

The fluid should be tested for identification of the cause.

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Risk and Complication Cardiac arrest

Myocardial infarction

Heart attack

Laceration of heart muscle

Arrythmias

Laceration of organs

Puncture of coronary arteries

Hemothorax

Pneumothorax

Pneumohemothorax