Overview
Thoracentesis is a procedure used to remove fluid or air from the pleural space for diagnostic or therapeutic purposes. It is essential for evaluating pleural effusions and relieving symptoms.
Thoracentesis is crucial for diagnosing the cause of pleural effusions, relieving dyspnea, and guiding treatment decisions. It can be both diagnostic and therapeutic.
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Indications
Evaluation of pleural effusion
Relief of dyspnea
Diagnosis and palliation
Infected pleural fluid
Blood in pleural space
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes patient consent, ultrasound guidance, sterile technique setup, and monitoring equipment. All team members should understand their roles.Step-by-Step Procedure
Step 1: Patient Preparation
Explain procedure, obtain consent, position patient, prepare sterile field.
⚠️ Common Mistakes to Avoid:
- Inadequate consent
- Poor positioning
- Incomplete sterile prep
💡 Pro Tip:
Position patient sitting with arms forward.
Step 2: Site Selection
Choose insertion site with ultrasound guidance.
⚠️ Common Mistakes to Avoid:
- Wrong site selection
- Poor ultrasound visualization
💡 Pro Tip:
Use ultrasound to identify optimal site and avoid vessels.
Step 3: Local Anesthesia
Infiltrate local anesthetic at insertion site.
⚠️ Common Mistakes to Avoid:
- Inadequate anesthesia
- Wrong technique
💡 Pro Tip:
Anesthetize skin, subcutaneous tissue, and pleura.
Step 4: Needle Insertion
Insert needle under ultrasound guidance, confirm pleural space.
⚠️ Common Mistakes to Avoid:
- Wrong insertion
- Lung injury
💡 Pro Tip:
Always confirm pleural space before advancing.
Step 5: Fluid Collection
Collect pleural fluid for analysis.
⚠️ Common Mistakes to Avoid:
- Inadequate collection
- Contamination
💡 Pro Tip:
Collect fluid in appropriate tubes for analysis.
Step 6: Drainage
Drain fluid as needed, monitor patient.
⚠️ Common Mistakes to Avoid:
- Excessive drainage
- Patient discomfort
💡 Pro Tip:
Limit drainage to 1-1.5L to prevent re-expansion pulmonary edema.
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Post-procedure Care
Post-procedure care involves monitoring for complications, chest X-ray confirmation, and analysis of pleural fluid.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Pneumothorax | 5-10% | Chest pain, dyspnea, decreased breath sounds | Chest X-ray, chest tube if needed | Ultrasound guidance, proper technique |
| Bleeding | 1-3% | Hemoptysis, hypotension | Pressure, monitoring | Ultrasound guidance, avoid vessels |
| Re-expansion pulmonary edema | 1-2% | Dyspnea, hypoxemia | Oxygen, diuretics | Limit drainage to 1-1.5L |
| Infection | 1-2% | Fever, erythema | Antibiotics | Sterile technique |
Clinical Pearls
Always use ultrasound guidance for safer insertion.
Position patient sitting with arms forward.
Always confirm pleural space before advancing.
Limit drainage to 1-1.5L to prevent re-expansion pulmonary edema.
Use sterile technique throughout the procedure.
Collect fluid in appropriate tubes for analysis.
Monitor for complications post-procedure.