Thoracentesis refers to the puncture by needle through the chest wall into the pleural space for the purpose of removing pleural fluid.
Indications
- To remove pleural fluid or air (both for diagnostic and therapeutic purposes)
- To induce pneumothorax
- To inject antibiotics in the case of empyema
Equipment Needed
A sterile tray containing:
- Sponge-holding forceps
- Syringes with needles
- Three-way stopcock with tubing
- Small bowl with antiseptic solution
- Specimen bottles and slides
- Gown, mask, and gloves
- Sterile dressing towels/slit
- Cotton swabs, gauze pieces, and pads
- 20-mL syringe with Luer lock (as necessary)
- A clean tray containing:
- Mackintosh and towel
- Kidney tray
- Tincture benzoin
- Procaine 1%
- Suction apparatus if needed)
General Instructions
- Sedation may be given in anxious child to prevent movement during procedure.
- The three-way stopcock should be fitted with needle before it is introduced into the chest cavity.
- The bevel of aspiration needle should be short to prevent pricking of the lungs.
- Remain with the child and watch his general condition during the procedure.
- Monitor vital signs during the procedure.
- Follow strict aseptic technique during the procedure.
- If any signs of complications are noted such as respiratory distress excessive coughing, crepitus, and hemoptysis, the aspiration is discontinued.
Preparation
- In order know the exact position of effusion, an X-ray chest should be done before thoracentesis.
- Explain the procedure to the parents and
the child as appropriate. - Get a written consent (hospital policy).
- Check vital signs.
- Make the child sits back on the bed and lean forward against a stool or chair back.
Procedure
- Perform hand hygiene and don gloves, mask, and gown.
- Prepare the chosen area (8th and 9th intercostal spaces in the posterior axillary line, or the area of maximum dullness) with antiseptic wipes.
- The area is infiltrated with 1% procaine down to the pleura.
- A large-bore needle with a syringe is inserted in the space along the upper edge of the lower rib. This is important to avoid injury to the intercostal nerves and blood vessels.
Note: Entry into the pleural cavity is indicated by a feeling of “give.” - With suction, the fluid begins to flow into the syringe.
- Not >100-500 mL should be removed at a time.
- When the needle is withdrawn, the skin puncture site should be sealed with tincture benzoin.
Post procedure Care
- Apply a sterile dressing and pressure bandage on the site.
- Position the child comfortably on the bed with the affected side up.
- Monitor the child for complications.
- Auscultate the lungs for breath sounds.
- Compare the chest movements on both sides.
- Check the puncture site for leakage of fluids.
- Monitor the vital parameters.
- If a water seal drainage system is used, the care should include as that of a client with under water seal drainage system.
- In older children, deep breathing exercises can be encouraged.
- Send the specimen for laboratory investigation as prescribed.
- Arrange for X-ray chest if indicated.
- Document the procedure in nurse’s record.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
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