Thoracentesis Procedure Steps

Thoracentesis is also known as thoracocentesis. It is a surgical procedure in which excessive pleural fluid is ejected from pleural space. Pleural space is a region present between chest wall and lungs outer covering. This procedure is performed in emergency patients and in hospitalized patients. If it is performed in hospitalized patient, then patient is asked to sign a consent form and then health care provider explains him the whole process. Patient is free to ask any question regarding procedure. Patient have to provide some information like

  • If patient is pregnant or not. 
  • Allergies to medications or sensitive to tape and latex. Allergic to anesthetics or not. 
  • Patient have to tell about his medication history which may include vitamins, OTC drugs, prescription drugs and any herbal medicines. 
  • Patient is asked about any pathological condition like bleeding disorder etc. 
  • If patient is on aspirin or other medicines which makes blood thin, then he is asked to quit them before Thoracentesis. 
  • Patient have to follow instructions given by health care provider. 

Before starting procedure, some tests are performed which are diagnostic tests. These diagnostic tests shows exact location of excess pleural fluid. These tests involve ultrasound, CT scan, chest X-ray and chest fluoroscopy. Patient is asked to take off his clothes before thoracentesis and wear hospital gown. Patient is also asked to remove any jewelry item he is wearing.  Then oxygen mask is applied or a nasal tube is used for breathing. Vitals like blood pressure, breathing and heart rate is monitored side by side during procedure. An ultrasound is done to view the exact location of thoracentesis to be performed. Ultrasound also helps to check the depth of needle.

Patient is asked to sit down on bed and relax his arms on a table higher than bed. This position enable ribs to spread and site is cleared to inject needle. If patient is not in a condition to sit then he is asked to lay down on bed facing sideways.  Chest wall between ribs is cleaned with an antiseptic solution and then local anesthesia is applied. When the area become numb, needle is injected through chest wall to pleural space from back side. Patient will experience pain while inserting needle. With pressure, blood will start filling needle. Patient have to stay still during process to avoid complications.

Patient is advised to take deep breath and at some points to stop breathe during this process.
To eject large amount of pleural fluid, a tube is attached to needle which collects fluid. Tubing will remain for some days and then removed.  After completing procedure, a bandage is applied on the site of needle until it totally recovers.  After thoracentesis, some tests are performed which shows progress of this procedure. These tests involve chest X-ray or ultrasound which is performed right after the procedure. This X-ray shows position of lungs. After sample collection, it is sent to lab for further process. These are the complete steps which are involved in procedure of thoracentesis.
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