Thoracentesis Position

Thoracentesis is a procedure in which excessive pleural fluid from pleural space is extracted and collected for two main purposes i.e. diagnostic purpose and treatment purpose. Thoracentesis is a safe procedure, but still care is required while performing thoracentesis. In this procedure, a needle is used to pass through chest wall from back side. This needle will help in ejecting excessive pleural fluid from pleural space. To make this procedure successful, positioning of patient during thoracentesis helps a lot. This can be performed in two main positions i.e. patient may lie on bed side facing side ways or may sit on bed with slightly tilted body. Sitting position is widely used position for thoracentesis. In bed side position, the dominant side is kept on upper side and then pleural fluid is ejected. Patient feels comfortable in this position.

A nasal tube or a face mask is used in both positions to facilitate oxygen supply. In case of sitting position, which is most common and preferred position used in thoracentesis, patient is allowed to sit on bed. Then he is advised to rest his arms on a bed side table which can be adjusted according to height of bed and patient comfort. Patient have to take off clothes before sitting. In sitting position, patient is slightly lean on table or pillow facing downward. This makes puncturing of skin easier with a needle. The area becomes visible and prominent. Physician’s assistant stand in front of patient holding him tight and does not let him move on needle insertion. Patient remains active in this position. Physician cleans the surface of chest wall with antiseptic and then puncture it with a needle or a plastic catheter. Patient may feel a little pain which resembles pinching. But feel less pain during ejection of pleural fluid.

The posterior gutter is deep and more likely to accumulate excessive pleural fluid in erected position, so needle is injected at this site during thoracentesis. In sitting position, this site is visible to physician. Back side of chest wall is used for needle injection, because interspaces are wider at back side as compare to front side. Preferred interspaces are 7th, 8th and 9th space of ribs. Another main reason is presence of neurovascular bundle near ribs so back side is more comfortable and easy for the procedure. Back side is perfect for this procedure because near 7th, 8th and 9th ribs space there are less chances of damage to spleen, diaphragm, liver and descending aorta. Sitting position is also preferred on bed side position because ribs interspaces are more prominent in sitting position leaning front side as compare to bed side position. Ejection of pleural fluid is easy in sitting position. After thoracentesis, bandage is applied to puncture site and patient is asked to take complete rest for at least 2 days. Physician also prescribe some medications i.e. pain killers for pain in puncture site. Physician also advise to take good care of puncture site and weash it regularly with Luke warm water and mild soap.
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