• Thoracentesis

    (Pleural Fluid Aspiration; Pleural Tap)

    Definition

    A pleural effusion is a build-up of fluid in the space between the lungs and the chest wall. This space is called the pleural space. Thoracentesis is a procedure to remove fluid from this area.
    There are two types of thoracentesis:
    • Therapeutic thoracentesis—to relieve the symptoms of fluid accumulation
    • Diagnostic thoracentesis—to test for the cause of the fluid build-up

    Reasons for Procedure

    There is always a small amount of fluid in the pleural space. The fluid helps to lubricate the area. When too much fluid builds up in this space, it can make it difficult to breathe.
    Your doctor may want to test some of the fluid after extracting it. The build-up of fluid can be a symptom of diseases or disorders, such as:
    Factors that may increase the risk of complications include:

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have a thoracentesis, your doctor will review a list of possible complications, which may include:
    • A collapsed lung
    • Fluid building up again
    • Bleeding
    • Infection
    • Damage to the liver or spleen
    Factors that may increase the risk of complications include:
    Factors that may increase the risk of complications include:
    • A history of lung surgery
    • A long-term, irreversible lung disease (such as emphysema or asthma )
    • Anything affecting normal blood clotting

    What to Expect

    Prior to Procedure

    Your doctor may order:
    • A complete physical exam
    • X-ray —a test that uses radiation to take a picture of structures inside the body
    • CT scan —a type of x-ray that uses a computer to make pictures of the inside of the body
    • Ultrasound—uses sound waves to make pictures of the inside of the body
    • Blood tests

    Anesthesia

    A local anesthetic will be used. It will numb the area where the needle will be inserted.

    Description of the Procedure

    You may be asked to sit upright on the edge of a bed or chair. Your arms will be resting on a nearby table. If your procedure involves a CT scan, you may be asked to lie on a table. Try to avoid coughing, breathing deeply, or moving during the procedure.
    A small patch of skin on your back, chest, or under your armpit will be sterilized. Anesthesia will be applied to this patch. It will help numb the area.
    The doctor may use ultrasound or CT scan images to locate the pleural fluid. A needle or thin plastic catheter will be inserted between your ribs. The needle or catheter is then passed into the pleural space. Some or all of the fluid will be drawn into the syringe. Your doctor may use CT images during your procedure. These images will help guide the needle and monitor the fluid.
    Placement of Thoracentesis Needle
    Placement of Thoracentesis Needle
    © 2011 Nucleus Medical Media, Inc.

    How Long Will It Take?

    About 15 minutes

    Will It Hurt?

    You may feel slight pain or a stinging when the needle is first inserted. As the fluid is being extracted, you may feel a sense of pulling. Tell your doctor or nurse if you feel extreme pain, any shortness of breath, or faint.

    Post-procedure Care

    At the Care Center
    If the thoracentesis is being done for diagnostic reasons, the fluid will be sent to a lab for testing. Often, another chest x-ray will be done to ensure that the fluid has been removed and that there is no sign of a collapsed lung.
    At Home
    Keep the area of skin where the needle was inserted clean and dry. To help make your recovery smooth, be sure to follow your doctor's instructions .
    If a diagnostic thoracentesis was done, ask your doctor when to expect the results.

    Call Your Doctor

    After arriving home, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the insertion site
    • Pain that you cannot control with the medicines you have been given
    • Cough, shortness of breath, or chest pain
    • Coughing up blood
    • Pain when taking a deep breath
    If you think you have an emergency, call for medical help right away.

    RESOURCES

    American Lung Association http://lungusa.org/

    American Thoracic Society http://www.thoracic.org/

    CANADIAN RESOURCES

    The Canadian Institutes of Health Information http://www.cihi.ca/cihiweb/

    The Canadian Lung Association http://www.lung.ca/

    References

    Harrison’s Principles of Internal Medicine . 16th ed. McGraw-Hill; 2005.

    Mason RJ. Murray & Nadel's Textbook of Respiratory Medicine . 4th ed. WB Saunders; 2005.

    Roberts JR. Clinical Procedures in Emergency Medicine . 4th ed. WB Saunders; 2004.

    6/3/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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