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.
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:
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 ProcedureA 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. AnesthesiaA 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 ProcedureA 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 Some or all of the fluid will be aspirated, or withdrawn into the syringe.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 ProcedureIf 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 fluidPulmonary edemaHemorrhaging or bleedingInfectionVery rarely, a puncture of the liver or spleen due to an unusually deep needle insertion Average Hospital StayIf 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 CareKeep 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. OutcomeIf 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. Call Your Doctor If Any of the Following OccursAny signs of infection (such as fever, chills, or swelling of the insertion area)Shortness of breath, coughing, or severe chest painNausea and vomiting RESOURCES: American Lung Associationhttp://lungusa.org American Thoracic Societyhttp://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 Associationhttp://www.lung.ca References: Mason RJ. Murray & Nadel's Textbook of Respiratory Medicine. 4th ed. WB Saunders; 2005. Harrisons 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, MDPlease 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.