Red flag to remember
Report sudden sharp chest pain, dyspnea, absent breath sounds, or tracheal deviation indicating pneumothorax.
What is thoracentesis?
It improves breathing by re-expanding the compressed lung. Memory aid: THORA = thorax fluid out; sit up and lean forward, stay still.
Key points to remember
- The patient sits upright leaning forward over a bedside table to widen the intercostal spaces and pool fluid at the lung base.
- Removing more than 1,000-1,500 mL at one time risks re-expansion pulmonary edema.
- The patient must hold still and avoid coughing or deep breathing during needle insertion to prevent lung puncture.
- Pneumothorax is the most serious complication and a post-procedure chest x-ray is commonly obtained to rule it out.
- The needle is inserted along the upper border of the rib to avoid the nerve and vessels that run along the lower rib margin.
- Pleural fluid is analyzed to distinguish transudate from exudate and to detect infection or malignancy.
Nursing priorities
- Verify informed consent, baseline vital signs, oxygen saturation, and breath sounds.
- Position the patient upright and leaning forward, supported on a table, and coach them to stay still.
- Monitor for respiratory distress, oxygen saturation, and vital sign changes throughout the procedure.
- After the procedure, apply an occlusive dressing, position on the unaffected side, and obtain the ordered chest x-ray.
- Document the amount, color, and characteristics of fluid removed and send specimens to the lab.
Labs & values
Pleural fluid protein-to-serum protein ratio greater than0.5 indicates an exudate (Light's criteria)
Pleural fluid LDH greater than2/3 the upper normal serum limit indicates an exudate
SpO2:95-100% (monitor before and after)
Patient teaching
- Remain as still as possible and try not to cough or breathe deeply while the needle is in.
- Tell the nurse right away if you feel short of breath or have chest pain afterward.
- You may feel pressure when the fluid is withdrawn, which is expected.
- Report any new cough or trouble breathing after you go home.
Red flags: report now
- Report sudden sharp chest pain, dyspnea, absent breath sounds, or tracheal deviation indicating pneumothorax.
- Report new cough, frothy or pink sputum, or hypoxia suggesting re-expansion pulmonary edema.
- Report hemoptysis or signs of bleeding such as hypotension and tachycardia.
- Never let the patient cough or move suddenly while the needle is in the pleural space.
References
Clinical references for this topic
Study Thoracentesis in the app4,000+ NCLEX questions with a rationale on every answer, NGN case studies and timed mock exams.See how CinnaRN works
Start free Want more Physiological Adaptation questions?We'll email you a free set on Thoracentesis. No account needed.
Was this helpful?