Thoracentesis Technique

Thoracentesis which is also known as thoracocentesis is a technique which clears excessive pleural fluid from pleural space. This technique is performed in the following way: patient 1st asked to take off his clothes and sit on bed leaning forward on bed side table or pillow for comfort. Then ultrasonography is performed to check presence of pleural fluid, area of fluid and its size. In ultrasonography, a curvilinear transducer or a high frequency linear transducer is used to obtain clear images. Diaphragm is clear and can be seen as a bright structure in it. In ultrasonography, complete respiratory cycle of patient is observed to examine area of fluid accumulation. The area which does not rise during respiration is spotted for thoracentesis. Ultrasonography also give information about volume of pleural fluid present between lungs and chest wall. It also confirms the site for needle puncturing.

Ultrasonography helps in reduction of complications associated with thoracentesis.
Commonly puncture site used is between 7th and 9th rib interspace. Sterile probe covers are used if thoracentesis is performed with the help of ultrssonography. Surface of skin is sterilized with an antiseptic. Chlorhexidine is commonly used antiseptic for clearing skin. It is more effective than povidone iodine solution because it dries fast. Physician also uses sterile towels to create a clean aseptic area surrounding the puncture site. If patient is in old age or obesse then a tape is used to stretch their loose skin and then clear the area for puncturing. A needle or a plastic two way catheter is used to inject. Commonly needle is used for diagnostic purpose, plastic catheter is also used sometimes. If a catheter is used to pass through chest wall then skin is 1st nicked with no. 11 scalpel blade to reduce resistance while inserting catheter.

During insertion of needle or catheter the neurovascular bundle should be avoided which is present with inferior rib side. If a needle is used, then a tube is attached to it for collection of fluid. A syringe pump or a vaccuum container is also used for collection of pleural fluid ejected from pleural space. While ejecting pleural fluid, patient experience symptomatic relief. After complete collection of pleural fluid, plastic catheter or needle is removed and bandage is applied to chest wall puncture site. Collected fluid is sent to lab for further tests and an ultrasonography is performed to check success of thoracentesis.

Patient is asked to take rest for at least 2 days and use medications after consulting doctor. Some pain killers are prescribed which should be continued until doctor ask to stop them. Patient have to focus on his diet and should not lift heavy weight. As ribs are involved in this procedure, so it is a sensitive procedure and requires great care during and after thoracentesis. If patient was already on some medications like blood thinning agents i.e. aspirin, warfarin etc. Then he have to ask doctor and stop using them before thoracentesis. As with these agents, there is a great risk of heavy bleeding during puncturing.
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