Thoracentesis (Pleural Fluid Aspiration, Pleural Tap)
Posted July 2, 2008 12:45 AM
Posted in
(Pleural Fluid Aspiration, Pleural Tap)
Pronounced: Thor-a-sen-TEE-sis
Definition
Thoracentesis is a procedure performed to remove excess fluid that has accumulated in the space between the outside of the lungs (called the pleura) and the chest wall. When fluid accumulates in this area, called the pleural space, it is called pleural effusion.
There are two types of thoracentesis:
- Therapeutic thoracentesis is performed to relieve the symptoms of fluid accumulation.
- Diagnostic thoracentesis is performed to test for the cause of the fluid build-up.
Reasons for Procedure
Usually, there is a small amount of fluid within the pleural space to help lubricate the area (less than one ounce of fluid). When too much fluid accumulates in the pleural space, it can cause discomfort and difficulty breathing. An accumulation of fluid can also be a symptom of other diseases or disorders, such as:
- Congestive heart failure (CHF)
- Lung infection (eg, bacterial pneumonia, viral infection, tuberculosis, fungal infection, or parasitic infection)
- Kidney disease (occurring from nephrotic syndrome or after peritoneal dialysis)
- Pulmonary embolism (a blot clot that travels to the lung)
- Cancer (eg, lung cancer, lymphoma, mesothelioma, or breast cancer)
- Cirrhosis of the liver
- After coronary artery bypass surgery (CABG)
If your physician feels you may have one of these diseases or disorders, he or she will test some of the fluid (diagnostic thoracentesis) after extracting it.
Risk Factors for Complications During the Procedure
Talk with your physician if you have any history of the following conditions:
- A history of lung surgery (scars from previous surgery can make the procedure more difficult)
- A long-term, irreversible lung disease (such as emphysema or asthma)
- Anything affecting normal blood clotting (such as medications like aspirin or warfarin) or a genetic disorder (eg, hemophilia)
What to Expect
Prior to Procedure
- A complete physical examination will be performed.
- Often, a chest x-ray will be performed to locate the precise location of the pleural effusion.
- Sometimes an ultrasound or CT scan is performed instead of an x-ray.
- Your doctor may run a CBC, or complete blood count, to make sure your immune system is functioning properly.
- You will usually be asked to sit upright on the edge of a bed or on a chair with your arms resting on a nearby table.
Anesthesia
A local anesthetic will be applied to the skin of your chest or back in the location where the needle will be inserted.
Description of the Procedure
- A small patch of skin on your back, chest, or under your armpit will be sterilized using a solution applied directly to the skin.
- The local anesthetic will be applied to help numb the area.
- A needle will be inserted above your rib into the area of the effusion (sometimes a thin plastic catheter is used as well).
- You should avoid coughing, breathing deeply, or moving during the procedure.
- Some or all of the fluid will be aspirated, or withdrawn into the syringe. The amount of fluid removed depends on the type of thoracentesis being performed.
- For diagnostic thoracentesis, around 2 to 3 oz is removed.
- For therapeutic thoracentesis, up to 35 oz can be removed at one time.
Placement of Thoracentesis Needle
© 2008 Nucleus Medical Art, Inc.
After Procedure
If the thoracentesis is being performed for diagnostic reasons, the fluid will be sent to a lab for testing. Often, another chest x-ray will be performed to ensure that the fluid has been removed.
How Long Will It Take?
The removal of excess pleural fluid usually takes around 15 minutes. In general, a therapeutic thoracentesis will take longer than one done for diagnostic purposes because more fluid is removed during the procedure.
Will It Hurt?
You may feel slight pain or a stinging sensation when the needle is first inserted. As the fluid is being extracted, you may feel a sense of “pulling” within your chest. Tell your doctor or nurse if you feel extreme pain, if you feel any shortness of breath, or if you feel faint.
Possible Complications
Complications from thoracentesis are uncommon, but can include the following:
- Pneumothorax (a collapsed lung)
- Reaccumulation of the fluid
- Pulmonary edema
- Hemorrhaging or bleeding
- Infection
- Very rarely, a puncture of the liver or spleen due to an unusually deep needle insertion
Average Hospital Stay
If there are no complications from the procedure itself, you will often be allowed to go home that same day. However, if you have other, coexisting conditions you may require a longer hospital stay. Talk with your physician about how long your stay could be.
Postoperative Care
Keep the area of skin where the needle was inserted clean and dry. If you experience any signs of infection, such as fever, swelling, or discharge from the needle insertion area, contact your physician immediately.
Outcome
If a diagnostic thoracentesis is being performed, your physician will want to view the test results before proceeding with any other treatments.
If a therapeutic thoracentesis is being performed, you may find you can breathe more easily after it has been completed, especially if you had a large amount of fluid build-up.
RESOURCES:
American Lung Association
http://lungusa.org
American Thoracic Society
http://www.thoracic.org
CANADIAN RESOURCES:
The Canadian Institutes of Health Information (CIHI)
http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=home_e
The Canadian Lung Association
http://www.lung.ca
References:
Mason RJ. Murray & Nadel's Textbook of Respiratory Medicine. 4th ed. WB Saunders; 2005.
Harrison’s Principles of Internal Medicine. 16th ed. McGraw-Hill; 2005.
Roberts JR. Clinical Procedures in Emergency Medicine. 4th ed. WB Saunders; 2004.
Last reviewed May 2008 by Rosalyn Carson-DeWitt, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.
Source: EBSCO
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