Thoracentesis

DOCUMENTATION

EQUIPMENT

  • Paracentesis Kit
  • chlorhexidine
  • sterile gauze
  • sterile drape
  • 6mL syringe
  • Needles for injection
  • Lidocaine
  • 18-gauge needle +/- catheter
  • 35mL syringe for aspiration
  • Drainage bag
  • Sterile occlusive dressing
  • Specimen tubes
  • Ultrasound
  • Sterile Probe Cover
  • Sterile Gloves

PROCEDURE

  • Positioning: Place the patient in a sitting position, leaning forward with arms on a bedside table.
  • The size of the effusion should be estimated by ultrasound if possible or auscultation and dullness to percussion
  • The needle should be inserted one or two spaces below the level of the effusion but above the 9th rib and lateral to the spine in the mid scapular line.
  • Mark the appropriate site or visualize with the ultrasound
  • Prep the skin with Chlorhexadine and apply the drape.
  • Anesthetize the skin by making a small wheal then insert anesthetizing needle to the pleural (even to the points of aspirating pleural fluid) and rib for appropriate anesthetic.
  • The aspiration needle and 35mL syringe +/- catheter are then inserted making sure to go immediately superior to the rib and avoid the neurovascular bundle that sits under the rib on the inferior surface.
  • Use negative pressure once through the epidermis.
  • Once pleural fluid is obtained continue aspirating fluid or slide the catheter over the needle, if catheter used, and then remove the needle.
  • The catheter must be covered to prevent the entry of air and drainage bag can be placed
  • No more than 1500 ml of fluid should be removed during the procedure.
  • When completed the needle or catheter is removed after telling the patient to breath out and hold.
  • The site is covered with a dressing.
    • The fluid must be sent for:
    • Protein
    • Lactate dehydrogenase
    • pH
    • Cell count and differential count
    • Gram stain and culture
    • Hematocrit
    • Cytology
    • Amylase level
    • Triglyceride level
    • Serum Protein and LDH should also be sent

PROCEDURE NOTE

Date:

Indication: Diagnostic/therapeutic removal of fluid from the pleural space

Resident:

Attending:

Consent was obtained and a time-out was completed verifying correct patient, procedure, site, and positioning. The patient was placed in appropriate dependent position for thoracentesis. The patient’s right(?)left thorax was prepped and draped in sterile fashion. 1% Lidocaine was(?)was not used to anesthetize the surrounding skin area. Ultrasound was(?)was not used to identify the fluid and observe the needle entering the pleural cavity. The needle was introduced into the pleural space. Appropriate fluid return was obtained and fluid was(?)was not removed for study. The needle was(?)was not attached to a drainage bag and ___mL of fluid were removed. The needle was then bandaged in place(?)removed. The patient tolerated the procedure well and there were no complications. Blood loss was minimal.Chest x-ray was(?)was not ordered to assess for pneumothorax.