Thoracocentasis: INTRODUCTION:-Thoracentasis Also Known As The Thoracocentasis or Plural Tap Is An

THORACOCENTASIS
INTRODUCTION :- Thoracentasis also known as the thoracocentasis or plural tap is an

invasive procedure to remove fluid or air from the pleural space for diagnostic or
therapeutic purposes. A cannula or hallow needle is carefully introduced into the thorax
generally after adminstration of local anesthesia.
The pleural space is the small space between the lungs and the chest wall. This space
typically contains approximately 4 teaspoon of fluid. Some conditions more fluids to enter
this space.
DEFINITION :-
According to I Clement :-
Thoracocentasis is defined as introducing a hollow needle into pleural cavity and aspirating
fluid or cur, using aseptic technique.
According to Brunner and suddarth’s :-
Thoracocentasis is defined as aspiration of fluid or air from the pleural space is performed
for diagnostic or therapeutic reasons.
PURPOSES :-
1. To remove excessive plural fluid (serous fluid, blood or pus).

2. To drain fluid /air from pleural cavity for diagnostic or therapeutic purposes.
3. To introduce medications.
4. To aid in full expansion of lung.
5. To obtain specimen for biopsy.
6. To take pleural biopsy for diagnostic examination.
7. To relieve pain.
8. To relieve breathlessness cause by accumulation of fluid or air in the pleural space.
9. To aid in diagnosis and treatment ( chemical, bacteriological, cellular, composition and
malignancy.)
GENERAL INSTRUCTION :-
1. The patients should prepared physiologically and psychologically for the procedure.
2. Thoracocentasis is indicated in case of pleural effusion due to infection, traumatic
injury, cancer or cardiac diseases etc.
3. Common site for throracentasis is just below the scapula at the seventh or eighth
intercostal space.
4. The patient should be warned that any sudden movements during the procedure may
caused injury to the lungs, blood vessels,etc.
5. The level of the aspiration needle should be short to prevent priking of the lungs.
6. Usually upright position is used during the procedure as it helps to callects the pleural
fluid at the base of the pleural cavity and hence facilitates to remove the fluid easily.
7. Maintain strict aseptic technique to prevent introduction of infection into the plural
space.
8. The three way adaptor should be fitted with the needle before it is introduced into the
chest cavity. The adoptor should be in introduced into the chest cavity. The adoptor
should be in a closed position to prevent the entry of air in to the pleural cavity.
9. The nurse should check the syringes and needle for air- tightness. If these are not air –
tight, then air will enter pleural cavity, which causes the lung collapse.
10. Remove the fluid slowly and not more than 1,000ml at a time, if the tap is therapeutic,
to prevent mediastinal shift.
11. Use water – seal drainage system, if pleural fluid is purulent and difficult to drain.
12. The specimen should be sent to the laboratory soon after it is callected.
13. The aspiration should be discontinued if any signs os complications are noted such as
sharp pain, respiratory distress, excessive coughing, crepitus hemoptysis, circulatory
collapse, etc.
PRILIMINARY ASSESSMENT :-
Check :-
1. The doctors order for any specific instructions.

2. Written informed conset of the patients or relatives.
3. General condition and diagnosis of the patients.
4. Review fresh erect chest x-ray.
5. Confirm the diagnosis, location and extent of the pleural air/ fluid/pus.
6. Acute respiratory insufficiency (tension pneumothorax, rapidly developing effusion
without dyspnea) may demand thoracentasis without x-ray.
7. Mental status of thr patients to follow instructions.
8. Articles available in the unit.
PREPARATION OF THE PATIENTS AND ENVIRONMENT :-
1. Explain the sequence of the procedure.

2. Provide privacy.
3. Chest x-ray should be taken before thoracentesis diagnose the location.
4. Check the vital signs and record it on the nurses record for reference.
5. Amild sedative may be given of the patient before starting the procedure.
6. Maintain the desired position of the patient, during the procedure.
7. The nurse should remain near the patient to observe and to remind not to move
during the procedure.
8. Arrange the articles at the bed side or in the treatment room.
9. Premedication injection atropin sulfate of 0.65 mg is given intramuscularly or
intravenously half an hour before the procedure.
EQUIPMENT :-
A sterile tray :-
 Sponge holding forceps 1

 Dissecting forceps 2
 Syring (5ml) and 2 needles for giving local anesthesia.
 Syring (20ml) with 1 leur lock to aspirate the fluid.
 Aspiration needle number 16 (long and short).
 Three way stopcock.
 Small bowel 2 to take the cleaning lotions.
 Specimen bottoles and slides.
 Cotton swabs, gauze pieces and cotton pads.
 Gown, masks and gloves for the doctor.
 Sterile dressing towels/slit.
An unsterile/clean tray:-
 Mackintosh and towel.

 Kidney tray and paper bag.
 Spirit, tincture of iodine and benzoin.
 Lignocain 2 percent.
 Suction apparatus with water seal drainage system.
PROCEDURE:-
NURSING ACTION RATIONAL
1. Identify patient and explain procedure to Allways anxiety and wins cooperation.
him and relatives. Explain that during
procedure he may experience a sensation
of deep pressure when fluid is aspirated.
2. Review the chest x-ray. x-ray shows localization of fluid and air in
plural cavity for determining puncture site.
3. Obtain an informed concent from patient. Avoid risk of legal complications.

4. Instruct patients that he should not move Any movements or coughing during
during procedure. procedure can cause injury to vital organs or
5. Position the patient comfortability. blood vessels.
a. Sitting on the edge of bed with the feet
supported, arms and head on pillows An upright position facilitates localization of
over the cardiac table. fluid at the the base of chest.
b. Straddling a chair with arms and head
resting on the back of the chair or
c. Lying on the unaffected side, with the
bed elevated 30-40 degree if patients
is unable to assume sitting position.
6. Expose the chest. The physician
determines the site for aspiration by Fluid usually localizes at the base of the chest.
visualizing chest x-ray and performing
chest percussion. If air is to be removed
the site is usually in 2nd and 3rd intercostal
space. If fluid is to be aspirated then site is
usually in the 8th and 9th intercostal space.
7. Clean the site with antiseptic solution and
assist the physician in administering local Reduces risk of infection.
anesthesia.
8. The physician introduces the
thoracentasis needle. Instruct the patients Respiratory movement can cause risk of
to hold his breath when needle is inserted. puncture to vital organs.
9. When needle is in pleural space, physician
aspirates pleural fluid with syring. Assits The three- way adapter helps in preventing
in callecting specimen in sterile air from entering the pleural cavity when
containers. large volumes of fluid is removed.
1. A 20ml syringe with a three- way
adapter is attached to the third post of
the three- way adapter.
2. If a considerable quantity of fluid is to
be removed, the needle is help in place
on the chest wall.
10. For therapeutic purpose usually 1000 –
1200ml of fluid is removed and for
diagnostic purpose 30 -60ml of fluid is
removed. Encourage patients to remain
still during the procedure and monitor
vital signs.
11. After needle is withdrawn, apply tincture Pressure dressing prevents risk of bleeding,
benzoin seal and pressure dressing over leakage and infectious at site.
the site.
12. Possition patient in bed with affected side This position minimises risk of possible fluid
up. He should remain in bed for 4 -6 hours leakage.
after procedure.
13. Maintain vital signs every half an hour for Complications may occur because of
4-6 hours or till steady. Observe patients accidental puncture of vital organs or blood
for complications such as shock, fainting, vessels.
low blood pressure, rapid pulse, rapid
respiration, uncontrolled cough and blood
tinged frothy sputum. Check breath
sounds in all lung fields.
14. Record the procedure with total amount
of fluid with drawn, colour nature and
signs of complications.
15. Send labeled specimen to laboratory.
16. Instruct patient to do deep breathing and
coughing exercises. Demonstrate and Deep breathing and coughing promotes lung
teach these excercises to patient. expansion.
17. Have a chest x-ray if indicated.
18. Wash articles used for thoracentasis in
cold water and then in warm soapy water.
Rinse, dry send for outoclaving. Wear
gloves while washing.
AFTER CARE :-
1. Instruct patients to lie on non – affected site for 1 hours. Ensure bed rest for 6 to 8
hours.
2. Monitor vital signs every half hour until stable.
3. Observe patient for signs and symptoms of hemothorax, tension pneumothorax,
subcutaneous emphysema and air embolism.
4. Administer analgesis and antibiotics as prescribed.
5. Instruct patients to carry out deep breathing exercises.
6. A chest x-ray may be taken to determine the effects of the procedure.
7. The puncture site should be treated aseptically to prevent contamination of the
wound.
8. The container with aspirated fluid should be labeled and sent to the laboratory with
requisition from.
9. Replace the articles after cleaning.
10. Wash hands thoroughly.
11. Record the procedure in the nurse’s record sheet.
COMPLICATION :-
Pneumothorax and hemothorax :- Sudden rise of sharp pain in the chest, persistent
cough, shortness of breath, fall in blood pressure, rapid pulse, anxiety, restlessness and
faintness, profuse sweating, pallor and cynosis.
Tension pneumothorax :- Marked dyspnea, cynosis, reduced or absence of breath sounds

and decreased movement of chest on respiration on the affected site. Acute chest pain,
increased pulse and respiratory rates. Shifting of the trachea to the unaffected side.
Mediastinal shift :- cynosis, severe dyspnea, deviation of larynx and trachea from their
normal midline position towards the unaffected side, shifting of the heart position to
maximum impulse and distended neck veins.
Pulmonary edema :- Blood – tinged frothy sputum, coughs, wheezing, severe dyspnea,
cynosis, tachycardia, tachypnea, distended neck, veins, signs of heart faiffure, peripheral
edema and altered level of consciousness.
SUMMARY :- Thoracentasis also known as the thoracocentasis or plural tap is an invasive

procedure to remove fluid or air from the pleural space for diagnostic or therapeutic
purposes. Definition,purpose, general instruction, preliminary assessment, equipment,
procedure, after care, complications.
CONCLUSION :- At the end of my procedure all students will be able to knowledge about
thoracocentasis.
BIBLIOGRAPHY :-
1. I Clement basic concepts of nursing procedure published by jypee 2 nd edition 2013

page no. 215 – 284.
2. LC Gupta, VC Sahu, Priya Gupta Practical nursing procedures 3 rd edition published
by jaypee page no. 279.
3. Annamma jacob Rekha R. Clinical nursing procedure the art of nursing practice.
Published by jaypee 3rd edition 2015 page no. 411.
4. Brunner & Suddarth’s Text book of medical surgical nursing published by wolters
kluwer 2013 twelth edition page no. 582.
5. Lippincott williams and wilkins mannual of nursing practice ninth edition published
by wolter kluwer page no. 206.

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What is the purpose of thoracentesis?

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THORACOCENTASIS

INTRODUCTION :- Thoracentasis also known as the thoracocentasis or plural tap is an

According to Brunner and suddarth’s :-

1. To remove excessive plural fluid (serous fluid, blood or pus).

1. The doctors order for any specific instructions.

PREPARATION OF THE PATIENTS AND ENVIRONMENT :-

1. Explain the sequence of the procedure.

 Sponge holding forceps 1

 Mackintosh and towel.

NURSING ACTION RATIONAL

3. Obtain an informed concent from patient. Avoid risk of legal complications.

Tension pneumothorax :- Marked dyspnea, cynosis, reduced or absence of breath sounds

SUMMARY :- Thoracentasis also known as the thoracocentasis or plural tap is an invasive

1. I Clement basic concepts of nursing procedure published by jypee 2 nd edition 2013

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