6.7 : Endoscopic Studies II: Thoracocentesis

Thoracentesis(Thoracocentesis), commonly known as pleural tap, is a medical procedure where a 22 gauge needle is inserted into the pleural space, the area between the lung and chest wall. This procedure is commonly performed to diagnose or treat various respiratory disorders.

Description

Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering the pleural space using a needle. It is done under local anesthesia to ensure patient comfort and safety. The patient is usually positioned upright with elbows on an overbed table and feet supported. In some cases, they might be in a side-lying position on the unaffected side.

The needle aspiration removes fluid and, very rarely, air from the pleural cavity. It also allows the collection of pleural fluid for analysis or a biopsy specimen from the pleural wall for diagnostic purposes. Once the procedure is complete, a pressure dressing is applied to the site. A chest radiograph is typically done after the procedure to rule out complications like pneumothorax (collapsed lung).

Purpose

Thoracentesis serves both diagnostic and therapeutic purposes. It can help analyze pleural fluid for culture and sensitivity, differential cell count, cytology, pH, total protein, lactic dehydrogenase, glucose, amylase, triglycerides, and cancer markers such as carcinoembryonic antigen. These tests aid in diagnosing conditions like infection, trauma, cancer, inflammatory diseases, or heart failure.

Therapeutically, it can relieve respiratory distress caused by excess fluid or air in the pleural space. Medication may sometimes be instilled directly into the pleural space to treat infection.

Nursing Responsibilities

Nurses play a crucial role in the assistance of thoracentesis. Their responsibilities encompass:

• Providing a comprehensive explanation of the procedure to the patient, ensuring they understand the associated sensations, such as pressure-like pain when the needle pierces the pleura and fluid is withdrawn.
• Assisting the patient in an appropriate position for the procedure and ensuring comfort.
• Maintaining asepsis during the procedure and monitoring vital signs, including pulse oximetry.
• During fluid removal, observing signs of complications such as respiratory distress, dyspnea, tachypnea, or hypotension.
• Applying a sterile pressure dressing to the site post-procedure and positioning the patient on the unaffected side for at least one hour.
• Ensuring the completion of chest radiography post-procedure and recording the amount, color, and other characteristics of the fluid removed.
• Monitoring for increased respiratory rate, asymmetry in respiratory movement, syncope or vertigo, chest tightness, uncontrolled cough or blood-tinged or frothy mucus, tachycardia, and hypoxemia after the procedure.

Conclusion

Thoracentesis is a critical procedure for diagnosing and treating various respiratory disorders. Ensuring patient safety and the efficacy of a procedure necessitates careful preparation, meticulous execution, and diligent follow-up care. Nurses are integral to this process, providing patient education, assistance during the procedure, and post-operative care.