Thoracentesis (Family Medicine)

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Any significant pleural effusion of unknown origin or large symptomatic effusion
  • Spontaneous pneumothorax
CONTRAINDICATIONS

Absolute Contraindications

  • Patient refuses the procedure.
  • Chest tube placement is planned and would be more appropriate.

Relative Contraindications

  • Coagulopathy or anticoagulant therapy or thrombocytopenia
  • Inability to cooperate or sign informed consent
  • Very small pleural effusions
  • Presence of factors likely to increase risks <(see Contraindications for more information)>
EQUIPMENT

Commercial thoracentesis or an assembled tray

Preparation and Anesthesia

  • Skin antiseptic and fenestrated drape or sterile towels
  • 10-mL Luer-Lok syringe
  • 25-gauge or smaller needle
  • 1½- to 2-inch, 22-gauge needle
  • Lidocaine 1% to 2% with epinephrine

Insertion

  • Sterile gloves
  • 50-mL Luer-Lok syringe, 3-way stopcock
  • 2½-inch, 18-gauge needle (for air), 2½-inch, 15-gauge needle (for fluid), or 16-gauge catheter over needle.
  • Specimen tubes

Optional

  • Sterile plastic tubing, curved clamp, vacuum bottles, monitoring equipment

Dressing

  • Sterile gauze pads and adhesive tape or adhesive bandage with antibiotic ointment
ANATOMY
  • Normally, only a small amount of fluid (~20 mL) is present in the pleural space.
  • Pleural fluid may collect in larger volumes with excessive hydrostatic pressure, increased capillary permeability, or lymphatic obstruction.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Obtain a post-thoracentesis chest radiograph:
    • If air was obtained or the patient is mechanically ventilated or develops cough, chest pain, hypoxia, or dyspnea during or after the procedure
    • For a small, primary spontaneous pneumothorax, observe the patient for at least 6 hours.
  • Monitor for hypoxemia.
  • Give the patient follow-up instructions.
COMPLICATIONS
  • Pneumothorax
  • Hemothorax
  • Solid organ laceration
  • Hypovolemia and reexpansion pulmonary edema
  • Retained catheter fragment
  • Failure to obtain fluid
  • Infection
  • Pain
  • Hypoproteinemia
RESULT ANALYSIS
  • Transudate
    • LDH levels in the fluid and pleural fluid/serum ratios for LDH and protein are all normal.
    • Most transudates result from congestive heart failure.
  • Exudate
    • Causes of exudates include cancer, pneumonia, trauma, tuberculosis, pulmonary embolism, pancreatitis, RA, and SLE.
  • Parapneumonic effusion
    • A low fluid pH (<7.2) can indicate a complicated parapneumonic effusion, which may require chest tube drainage.
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