Today our topic of discussion is General Instruction of Thoracentesis.
General Instruction of Thoracentesis
General Instructions
- The patient should be prepared physically and psychologically for the procedure
- Thoracentesis is indicated in case of pleural effusion due to infection, traumatic injury, cancer or cardiac diseases, etc.
- Common site for thoracentesis is just below the scapula at the seventh or eighth intercostal space
- The patient should be warned that any sudden movements during the procedure may cause injury to the lungs, blood vessels, etc.
- The level of the aspiration needle should be short to prevent pricking of the lungs
- Usually upright position is used during the procedure as it helps collect the pleural fluid at the base of the pleural cavity and hence facilitates to remove the fluid easily
- Maintain strict aseptic techno prevent introduct of infection into the pleural space
- The 3 way adaptor should be fitted with the need before it is introduced into the chest cavity.
- The adapte should be in a closed position to prevent the entry of a into the pleural cavity entering The nurse should check the syringes and needle fort aix tightness.
- If these are not air-tight, air may be e the pleural cavity and collapse ml.uta.
- Remove the fluid slowly and not more than 1000 time, if the tap is therapeutic to prevent mediastinal sh.
- Use water: Seal drainage system, if pleural fluid is purulent and difficult to drain
- The specimen should be sent to the laboratory sou after it collected
- The aspiration should be discontinued if any signs of complications are noted such as sharp pain, respiratory distress, excessive coughing, crepitus, haemoptysis circulatory collapse, etc.
Preliminary Assessment
- Check
- Doctors order for any specific instructions
- Written informed consent of the patient or relatives
- General condition and diagnosis of the patient
- Review fresh erect chest X-ray Confirm the diagnosis, location and extent of the pleural
- air/fluid/pus
- Acute respiratory insufficiency (tension pneumothorax, rapidly developing effusion without dyspnea) may demand thoracocentesis without X-ray/
- Mental status of the patient to follow instructions
- Articles available in the unit.
Preparation of the Patient and Environment
- Explain the sequence of the procedure
- Provide privacy
- Chest X-ray should be taken before thoracentesis is done to diagnose the location
- Check the vital signs and record it on the nurse’s record for reference
- A mild sedation may be given to the patient before starting the procedure
- Maintain the desired position during the procedure
- The nurse should remain near the patient to observe him and to remind him not to move during the procedure
- Arrange the articles at the bedside or in the treatment room.
- Premedication-inj, atropine sulfate 0.65 mg intramus cularly or intravenously half an hour before procedure.