Thoracentesis is a medical procedure designed to address the accumulation of excess fluid or air in the space surrounding the lungs. It aims to alleviate symptoms, such as difficulty breathing, and to help diagnose the underlying causes of such fluid buildup.
What is a Thoracentesis and Why is it Performed?
Thoracentesis involves removing fluid or air from the pleural space, the narrow area between the lungs and the inner chest wall. This space normally contains a small amount of lubricating fluid, allowing the pleura (membranes lining the lungs and chest wall) to glide smoothly during breathing. However, medical conditions can cause an abnormal accumulation of fluid, known as a pleural effusion, which pressures the lungs and impedes their expansion.
The procedure is primarily performed for two main reasons: to relieve symptoms and to aid in diagnosis. When excessive fluid in the pleural space causes symptoms like shortness of breath or chest discomfort, removing the fluid can provide immediate relief and improve respiratory function. Additionally, the fluid collected during thoracentesis can be analyzed in a laboratory to identify the specific cause of the effusion.
Many conditions can lead to fluid buildup in the pleural space. Common causes include congestive heart failure, infections (such as pneumonia or tuberculosis), certain cancers, autoimmune diseases like lupus, pulmonary embolism, liver failure, kidney disease, and pancreatic inflammation.
How the Procedure is Carried Out
Thoracentesis is typically performed in a hospital or clinic, often as an outpatient procedure. The patient usually sits upright, leaning forward with arms resting on a table. This position widens the rib spaces for better access. If sitting is not possible, the patient may lie on their side.
Before the procedure, the skin around the insertion site on the back is cleaned with an antiseptic solution. A local anesthetic is then injected to numb the area, causing a brief stinging sensation. Once numb, a thin needle or catheter is carefully inserted between two ribs into the pleural space.
Medical professionals often use ultrasound imaging to precisely locate the fluid and guide the needle, enhancing safety. Once the needle or catheter is in place, fluid slowly drains into a collection bag. The patient may be asked to remain still or hold their breath to prevent lung injury. The procedure generally takes 15 to 30 minutes, but can take longer if a large volume of fluid is removed. After fluid removal, the needle is withdrawn, a sterile dressing is applied, and a chest X-ray or ultrasound may be performed to confirm lung status.
Patient Experience: Before, During, and After
Before a thoracentesis, healthcare providers conduct imaging tests, such as a chest X-ray or ultrasound, to determine fluid location and amount. Patients must inform their doctor about all medications, especially blood thinners, as adjustments may be needed to reduce bleeding risk. Blood tests may also check kidney function and clotting ability.
During the thoracentesis, patients remain awake. They will feel a sharp stinging or pinching sensation when the local anesthetic is injected. As the needle is inserted, pressure or discomfort may occur, but it should not be painful. Patients might also experience a pulling sensation or the urge to cough as the fluid drains and the lung re-expands. Patients should communicate any chest pain, shortness of breath, or faintness to the medical staff, who will closely monitor vital signs like heart rate and blood pressure.
After the procedure, medical staff monitor vital signs and check the dressing for bleeding or fluid leakage. Most individuals can return home the same day, but should have someone else drive them. Patients should avoid strenuous physical activity for 24 to 48 hours. A mild cough is common as the lungs expand.
Monitoring for Signs After the Procedure
After returning home from a thoracentesis, it is important to monitor for signs of complication. While mild discomfort at the needle insertion site is expected, report worsening pain to a healthcare provider. Contact your doctor if you develop a fever of 100.4°F (38°C) or higher, as this could signal an infection.
Signs of infection at the puncture site, such as increased redness, swelling, warmth, or green or yellow discharge with a foul odor, warrant immediate medical attention. Any fluid draining from the puncture site or significant bleeding should be promptly reported. While mild coughing is normal, new or worsening shortness of breath or difficulty breathing requires urgent medical evaluation. Seek emergency medical care immediately if severe chest pain, sudden worsening shortness of breath, or coughing up blood occurs.