Thoracentesis

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Thoracentesis is a medical procedure to remove some of the excess fluid surrounding the lungs which there is a pleural effusion.  

Therapeutic thoracentesis is used as a treatment to decrease symptoms from a pleural effusion. All that extra fluid may make you feel short of breath. Removing some of it may help you feel more comfortable.1

Diagnostic thoracentesis is used in diagnosis. For example, it is likely you will need thoracentesis if you have a new pleural effusion and if the medical reason for it is not clear. Detailed analysis of the fluid in a lab can help identify the source of your problem. This type of thoracentesis usually removes a smaller amount of fluid compared to a therapeutic thoracentesis.

Sometimes thoracentesis can be used for diagnosis and therapy simultaneously, to provide immediate symptom relief while narrowing in on a diagnosis.

 

Causes of Pleural Effusion

It’s depended on the protein concentration in the pleural fluid.

if the protein is low (transudate) the most common causes are cardiac, renal and liver diseases, if the protein is high (exudate) the most common causes are inflammatory, infectious and neoplastic diseases.

Contraindications

 Severe oculopathy, severe respiratory failure, certain lung diseases such as emphysema, Hypotension. People who are unable to sit still for the procedure are also not able to have it safely.   or in people receiving ventilator support.

Before the Procedure

Before the thoracentesis, your healthcare provider will talk to you about all your medical conditions, perform a physical exam, and assess your health.

You must tell your doctor If you take medications that affect your blood (like aspirin, warfarin)

it better to be fasting for a few hours before the procedure.

the procedure will take about 15 minutes, can be done in the operation theater or bedside or in the office under local anesthesia, and guided by ultrasound if the fluid amount is little, most people sit while their heads and arms resting on a table.

Don’t hesitate to ask your clinician any questions about the procedure.

After the Procedure

you will receive a chest X-ray afterward; you need to be monitored for a while That’s because thoracentesis sometimes causes complications. If you are doing well, you may be able to go home in a few hours.

Potential Complications

The most common potentially serious complication of thoracentesis is pneumothorax. Some other possible problems include:

• Re-expansion pulmonary edema (REPE)

• Damage to the spleen or liver

• Infection

• Air embolism

• Shortness of breath

• Pain

• Bleeding

In some cases, these complications might mean that you will need to stay longer at the hospital. Some might require treatment, such as insertion of a chest tube if you get a large pneumothorax. Other times, monitoring will be enough. The serious complications are relatively rare.

Contacting Your Healthcare Provider

 contact your healthcare provider promptly if you experience symptoms after going home, like:

chest pain

bleeding from the needle site

sudden difficulty breathing

a bloody cough

 

Tests of Fluid Gathered from Thoracentesis

The fluid appearance provides some key clues about the general cause of fluid accumulation. Some common tests that might be run on the fluid include the following:

• Glucose

• Ph

• Cell count

• Protein

• Tests for bacteria

• Lactate dehydrogenase

A sample of fluid can be sent to pathology if there is any doubt of malignancy.