Indications – The indication for large volume thoracentesis is
dyspnea due to a moderate to large pleural effusion confirmed by physical examination and chest radiography
.
Which condition is a contraindication for thoracentesis?
Relative contraindications to diagnostic thoracentesis include a small volume of fluid (< 1 cm thickness on a lateral decubitus film),
bleeding diathesis
or systemic anticoagulation, mechanical ventilation, and cutaneous disease over the proposed puncture site.
Who needs a thoracentesis?
Thoracentesis can help diagnose health problems such as:
Congestive heart failure
(CHF), the most common cause of pleural effusion. Viral, fungal, or bacterial infections. Cancer.
Why would you need a thoracentesis?
Thoracentesis is performed to:
relieve pressure on the lungs
.
treat symptoms
such as shortness of breath and pain. determine the cause of excess fluid in the pleural space.
Which of the following is NOT AT indication of thoracentesis?
There are no absolute contraindications for thoracentesis. Relative contraindications include the following:
Uncorrected bleeding diathesis
.
Chest wall cellulitis
at the site of puncture.
How painful is a thoracentesis?
You may
feel discomfort or pain in your shoulder
or the area where the needle was inserted. This might happen toward the end of your procedure. It should go away when the procedure is finished, and you shouldn’t need medication for it.
What kind of doctor does a thoracentesis?
The following specialists perform thoracentesis:
Pulmonologists
specialize in the medical care of people with breathing problems and diseases and conditions of the lungs. Pediatric pulmonologists specialize in the medical care of infants, children and adolescents with diseases and conditions of the lungs.
At what level is thoracentesis done?
In order to minimize potential injury of the diaphragm, the lowest recommended level for thoracentesis is
between the eighth and ninth ribs (eighth intercostals space)
. Mark the area of needle insertion by pressing a pen or pen cap firmly on the skin creating an indentation that will remain after the ink is washed off.
What are the materials needed for thoracentesis?
- Local anesthetic (eg, 10 mL of 1% lidocaine), 25-gauge and 20- to 22-gauge needles, and 10-mL syringe.
- Antiseptic solution with applicators, drapes, and gloves.
- Thoracentesis needle and plastic catheter.
- 3-way stopcock.
- 30- to 50-mL syringe.
- Wound dressing materials.
Which needle is used for thoracentesis?
Using
a 22 or 25-gauge needle
form a skin wheel with anesthetic at the marked injection site. A longer needle than those supplied in the standard kit may be required depending on the amount of subcutaneous tissue.
Can thoracentesis cause death?
The short-term mortality in patients undergoing thoracentesis for pleural effusion is high, with
over 20% of patients dying within 30- days
.
How long does a thoracentesis take?
The procedure will take
about 15 minutes
. Most people go home shortly after. You can go back to work or your normal activities as soon as you feel up to it. If the doctor sends the fluid to a lab for testing, it usually takes a few hours to get the results.
How many times can you get a thoracentesis?
Depending on the rate of fluid reaccumulation and symptoms, patients are required to undergo thoracentesis from
every few days to every 2–3 weeks
.
How do you interpret pleural fluid?
- The ratio of pleural fluid to serum protein is greater than 0.5.
- The ratio of pleural fluid to serum LDH is greater than 0.6.
- The pleural fluid LDH value is greater than two-thirds of the upper limit of the normal serum value.
What is the difference between Thoracostomy and thoracentesis?
Thoracocentesis may be performed using a butterfly needle or vascular catheter, usually attached to a syringe via extension tubing and a three-way tap. Most thoracostomy tubes were wide-bore tubes requiring a trocar to place them. In humans, these techniques are no longer recommended because of high complication rates.
When should a thoracentesis be diagnosed?
Thoracentesis should be performed diagnostically
whenever the excessive fluid is of unknown etiology
. It can be performed therapeutically when the volume of fluid is causing significant clinical symptoms. Typically, diagnostic thoracentesis is a small volume (single 20cc to 30cc syringe).
