2-23
Section V. PULMONARY DRAINAGE
2-23. THORACENTESIS
a. General. Thoracentesis is the procedure in which a puncture is made into the chest wall to withdraw fluid or air from the pleural cavity for diagnostic or therapeutic purposes. A thoracotomy needle is inserted through the intercostal area into the pleural cavity. Suction is then applied by syringe to aspirate the accumulated fluid or air. The procedure is usually done at the patient's bedside.
b. Assembling the Necessary Equipment. Assemble the following:
(1) Sterile thoracentesis tray (obtain from CMS).
(2) Calibrated drainage bottle.
(3) Sterile gloves.
(4) 4x4 gauze compresses.
(5) Prescribed local anesthetic.
(6) Alcohol prep sponges.
(7) Adhesive tape.
(8) Mobile table or stand.
(9) Waste receptacle.
c. Preparation for the Procedure.
(1) Check clinical record for signed SF 522 (Authorization for Administration of Anesthesia and for Performance of Operations and Other Procedures).
(2) Obtain chest X-rays, if requested.
(3) Explain the procedure to the patient, stressing the importance of remaining immobile during the procedure.
(4) Take and record TPR and blood pressure (BP).
(5) Screen the patient. Remove pajama jacket to expose chest. The site of the puncture will depend upon the location of the fluid or air that is to be aspirated.
(6) Position the patient as directed by the physician. The position may be either one of the following or a similar position, as directed by the physician.
(a) Seat the patient on the side of the bed, facing away from the physician, with feet supported on a chair and the head and arms resting on an overbed table padded with pillows. The arms are elevated slightly to widen the intercostal spaces.
(b) Place the patient in a semi recumbent position, facing away from the physician, resting on the non-affected side, with the head of the bed elevated about 45 degrees. A pillow is placed under the chest to widen the intercostal spaces. The arm of the affected side is placed above the head to elevate the ribs, thereby making the insertion of the needle easier.
d. Assisting with Thoracentesis.
(1) Place the thoracentesis tray on instrument table. Open sterile wrapper cover to provide a sterile field.
(2) Place other supplies on adjacent bedside stand or over bed table. Open glove wrapper.
(3) Assist with handling of local anesthetic vial. Hold vial with label uppermost so that the physician can personally check the label before withdrawing any of the solution. Cleanse stopper with alcohol sponge. Invert vial and hold firmly while the doctor, with gloved hands, withdraws the required solution.
(4) Support and help patient to avoid moving and coughing while the thoracentesis needle is introduced.
(5) Assist as directed with collection of specimens as the physician manipulates the syringe, the stopcock, and drainage tubing. Use care not to contaminate the end of the tubing, the cap, or the open end of the specimen tubes. Cap the tubes and place them upright in a clean glass provided for this purpose. Label each tube as directed by the physician.
(6) If drainage of a large amount of accumulated fluid is necessary, assist the doctor by placing the free end of the tubing in the drainage bottle.
(7) Watch the patient's color; check pulse and respiration. Immediately report any sudden change, as this may indicate damage to the visceral pleura from a nick or puncture by the needle.
(8) After the needle is withdrawn, apply a sterile dressing over the puncture site.
(9) Position patient comfortably (usually Fowler's position).
e. Follow-up Procedures.
(1) Remove equipment from bedside to utility room.
(2) Complete entries on appropriate laboratory request forms as directed.
(3) Send properly labeled specimens with completed request forms to laboratory immediately.
(4) Measure and record amount of fluid withdrawn and discard this fluid unless directed otherwise.
(5) Discard disposables, place all linen in hamper, and return appropriate items to CMS.
(6) Continue to observe patient for respiratory difficulty: persistent cough, dyspnea, or the presence of blood in the sputum. Take and record vital signs q4h (every 4 hours), or as ordered.
(7) Obtain post-procedural chest X-rays, if ordered.
(8) Enter the following information on Nursing Notes: date and time, procedure, by whom performed, amount and type of fluid withdrawn, patient's reactions, and specimens sent to laboratory.
