Thoracentesis
Definition
Thoracentesis (thoracocentesis or pleural tap) is an invasive procedure to remove fluid
or air from the pleural space for diagnostic or therapeutic purposes.
Procedure
A cannula, or hollow needle, is carefully introduced into the thorax under local anesthesia.
position : patient is made to sit and lean on a cardiac bench
Location
Midaxillary line - 6th 7th 8th intercostal space
Indication
Diagnostic : Fluid accumulation in the pleural cavity; for analysis of pleural fluid
Therapeutic : Large amount of fluid
Common causes of pleural effusions are cancer, congestive heart failure, pneumonia,
PT, and recent surgery.
Tube thoracostomy, the placement of a large tube in the pleural space done if needed, like in empyema
Contraindications
An uncooperative patient or a coagulation disorder that can not be corrected are
absolute contraindications.
Relative contraindications - bullous emphysema, only one functioning lung (due to
diminished reserve).
Complications
Pneumothorax
hemopneumothorax
hemorrhage
hypotension (low blood pressure due to a vasovagal response)
Reexpansion pulmonary edema.
Dry tap
Subcutaneous hematoma or seroma, anxiety
Dyspnea and cough (after removing large volume of fluid).
The fluid is either transudate or exudate.
Exudate
Hemorrhage
Infection
Malignancy
Empyema
Transudate
Congestive heart failure
Nephrotic syndrome
Hypoalbuminemia
Cirrhosis
Superior vena cava obstruction
Analysis of the fluid
Amylase
A high amylase level acute or chronic pancreatitis, ruptured pancreatic pseudocyst cancer or esophageal rupture.
Glucose
low in:
rheumatoid effusion
lupus effusion
bacterial empyema
malignancy
tuberculosis
esophageal rupture (Boerhaave syndrome)
Triglyceride and cholesterol
Chylothorax : the presence of chylomicrons indicate a chylous effusion. Milky.
Rupture of the thoracic duct due trauma or malignancy (such as lymphoma).
Cell count and differential
Cultures and stains
Cytology to detect malignancy - metastatic, mesothelioma
