Thoracentesis, Assisting
Thoracentesis involves aspiration of fluid or air from the pleural space. It relieves pulmonary compression and respiratory distress by removing accumulated air or fluid that results from injury or such conditions as tuberculosis, cancer, and heart failure. It also provides a specimen of pleural fluid or tissue for analysis and allows instillation of chemotherapeutic agents or other medications into the pleural space.
Thoracentesis is contraindicated in patients with bleeding disorders and should be used cautiously in patients who don’t cooperate well, who have uncontrolled coughing, whose pleural fluid location is uncertain, who have only one functional lung, or who are on positive end-expiratory pressure mechanical ventilation.
Equipment
Most facilities use a prepackaged thoracentesis tray that typically includes the following:
Sterile gloves ▪ sterile drapes ▪ 1% or 2% lidocaine ▪ 5-mL syringe with 21G and 25G needles for anesthetic injection ▪ 17G thoracentesis needle for aspiration or Teflon over-the-needle catheters ▪ 50-mL syringe ▪ three-way stopcock and tubing ▪ sterile specimen containers ▪ sterile hemostat ▪ sterile 4″ × 4″ gauze pads ▪ antiseptic cleaning swabs.
You’ll also need the following:
Sterile marker ▪ sterile labels ▪ adhesive tape ▪ sphygmomanometer or electronic vital signs monitor ▪ gown ▪ face shield ▪ gloves ▪ stethoscope ▪ laboratory request slips ▪ drainage bottles ▪ clippers ▪ biopsy needle ▪ prescribed sedative with 3-mL syringe and 21G needle ▪ drainage bottles if the doctor expects a large amount of drainage.
Preparation of Equipment
Gather all equipment at the patient’s bedside or in the treatment area. Check the expiration date on each sterile package, and inspect for tears. Prepare the necessary laboratory request form. List current antibiotic therapy on the laboratory forms because this factor will be considered in analyzing the specimens.
Implementation
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.4
Confirm that an informed consent has been obtained and that it is documented in the medical record.5
Note any drug allergies, especially to the local anesthetic.
Have the patient’s chest X-rays available.
Conduct a preprocedure verification to make sure that all relevant documentation, related information, and equipment are available and correctly identified to the patient’s identifiers.6
Explain the procedure to the patient. Inform him that he may feel some discomfort and a sensation of pressure during the needle insertion.
Provide privacy and emotional support.
Verify that the doctor has marked the procedure site with his initials or with another unambiguous mark set by your facility’s policy before the procedure is performed. Confirm that the correct procedure has been identified for the correct patient at the correct site.6
Administer the prescribed sedative or analgesia as ordered, following safe medication administration practices.7
Obtain baseline vital signs, and assess respiratory function. Auscultate the patient’s breath sounds.
Position the patient. Make sure he’s firmly supported and comfortable. (See Positioning for thoracentesis.)
Remind the patient not to cough, breathe deeply, or move suddenly during the procedure to avoid puncture of the visceral pleura or lung. If the patient coughs, the doctor will briefly halt the procedure and withdraw the needle slightly to prevent puncture.
Expose the patient’s entire chest or back as appropriate.
Clip hair from the aspiration site if needed.
Perform hand hygiene; put on gloves, a gown, and a face shield; and follow standard precautions.1,2,3
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
