What is Thoracentesis?

Thoracentesis is a procedure which is performed to clear or remove fluid from pleural space. Pleural space is an empty area which is present between the lungs and the chest wall. In this procedure, a fine needle is used to insert right through chest wall. Sometimes instead of using needle, a plastic catheter is used. Ultrasound during thoracentesis helps surgeon to place needle accurately at right place. With the help of this needle, pleural fluid is extracted and then sent to lab for further tests. These tests show the underlying cause behind buildup of this fluid. In normal physiology, a little amount of pleural fluid is present in pleural space.

But excess production and accumulation of thoracentesis can occur due to many pathological conditions like inflammation, infection, cancer or heart failure. Presence of excessive pleural fluid hinders during normal breathing. Diagnostic tests include chest x-ray. Physical examination is also performed for pleural fluid diagnosis. Test results may take about 1 to 2 working days. If pleural sample is used to check the presence of tuberculosis, then it will take several weeks.  Thoracentesis is performed for two purposes. 1st one include finding the leading cause behind excessive pleural fluid. 2nd one involves treatment by extracting pleural fluid and decreasing pain.

Before starting thoracentesis, patient is asked to sign a consent form about risks. Patient have to provide all medication history or current medication profile, about allergic medications and about bleeding issues. There are some pathological conditions in which thoracentesis cannot be performed. Those pathological conditions involve irreversible lung disease i.e. emphysema. This procedure is prohibited in patients with bleeding disorder and patients with enlarged heart size from right side or heart failure.

Patient is asked to take off his clothes and then let him sit and lean forward to padded bed side table. Then surgeon clean his chest region with an anti-septic. Then local anesthetic is given to patient in chest region. When the chest region becomes numb, surgeon inserts a long needle through chest and then fluid is extracted. Patient may experience a mild pain and pressure due to extraction process. A vacuum bottle is attached to a small tube or syringe to collect pleural fluid. After the collection of excessive pleural fluid, needle is removed and bandage is applied to site. This whole procedure will be done in almost 10 to 15 minutes.

After one or two days, an X-ray is performed to check success of this procedure and complications (if any). Thoracentesis can be performed again and again. This is a safe procedure with less complications. Some of the complications are as follows:

1. If a very large amount of pleural fluid is removed, then pulmonary edema may occur.

2. Bleeding may complicate the procedure.

3. Any kind of lung infection.

4. Rarely, liver and spleen may damage as a result of Thoracentesis.

Pneumothorax can occur i.e. lung become partially collapse. It occurs if during thoracentesis, needle used accidentally punctures lung and air from lungs flow out.
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