A thoracentesis (aspiration of fluid or air from the pleural space) is performed on patients with various clinical problems. A diagnostic or therapeutic procedure, thoracentesis may be used for:
• Removal of fluid and air from the pleural cavity
• Aspiration of pleural fluid for analysis
• Pleural biopsy
Instillation of medication into the pleural space
The responsibilities of the nurse and rationale for the nursing actions are summarized below.
1. Ascertain in advance that a chest x-ray has been ordered and completed and the consent form has been signed.
2. Assess the patient for allergy to the local anesthetic to be used.
Administer sedation if prescribed.
3. Inform the patient about the nature of the procedure and:
a. The importance of remaining immobile
b. Pressure sensations to be experienced
c. That minimal discomfort is anticipated after the procedure
4. Position the patient comfortably with adequate supports. If possible,
place the patient upright or in one of the following positions:
a. Sitting on the edge of the bed with the feet supported and
arms and head on a padded over-the-bed table
b. Straddling a chair with arms and head resting on the back of
c. Lying on the unaffected side with the bed elevated 30 degrees
to 45 degrees if unable to assume a sitting position.
5. Support and reassure the patient during the procedure.
a. Prepare the patient for the cold sensation of skin germicide
solution and for a pressure sensation from infiltration of local
b. Encourage the patient to refrain from coughing.
6. Expose the entire chest. The site for aspiration is visualized by chest x-ray film and percussion. If fluid is in the pleural cavity, the thoracentesis site is determined by the chest x-ray, ultrasound scanning, and physical findings, with attention to the site of maximal dullness on percussion.
7. The procedure is performed under aseptic conditions. After the skin is cleansed, the physician uses a small-caliber needle to inject a local anesthetic slowly into the intercostal space.
8. The physician advances the thoracentesis needle with the syringe attached. When the pleural space is reached, suction may be applied with the syringe.
a. A 20-mL syringe with a three-way stopcock is attached to the needle (one end of the adapter is attached to the needle and the other to the tubing leading to a receptacle that receives the fluid being aspirated).
b. If a considerable quantity of fluid is removed, the needle is held in place on the chest wall with a small hemostat.
9. After the needle is withdrawn, pressure is applied over the puncture site and a small, sterile dressing is fixed in place.
10. Advise the patient that he or she will be on bed rest and a chest x-ray will be obtained after thoracentesis.
11. Record the total amount of fluid withdrawn from the procedure and document the nature of the fluid, its color, and its viscosity.
If indicated, prepare samples of fluid for laboratory evaluation. A specimen container with formalin may be needed for a pleural biopsy.
12. Monitor the patient at intervals for increasing respiratory rate; asymmetry in respiratory movement; faintness; vertigo; tightness in chest; uncontrollable cough; blood-tinged, frothy mucus; a rapid pulse; and signs of hypoxemia.