Are you awake during a thoracentesis?
Pleural fluid aspiration; Pleural tap Thoracentesis is a procedure to remove fluid from the space between the lining of the outside of the lungs (pleura) and the wall of the chest. The test is done in the following way: How to Prepare for the TestNo special preparation is needed before the test. A chest x-ray or ultrasound will be done before and after the test. How the Test will FeelYou will feel a stinging sensation when the local anesthetic is injected. You may feel pain or pressure when the needle is inserted into the pleural space. Tell your provider if you feel short of breath or have chest pain, during or after the procedure. Why the Test is PerformedNormally, very little fluid is in the pleural space. A buildup of too much fluid between the layers of the pleura is called a pleural effusion. The test is performed to determine the cause of the extra fluid, or to relieve symptoms from the fluid buildup. Normal ResultsNormally the pleural cavity contains only a very small amount of fluid. What Abnormal Results MeanTesting the fluid will help your provider determine the cause of pleural effusion. Possible causes include:
If your provider suspects that you have an infection, a culture of the fluid may be done to test for bacteria. RisksRisks may include any of the following:
ConsiderationsA chest x-ray or ultrasound is commonly done after the procedure to detect possible complications. ReferencesBlok BK. Thoracentesis. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 9. Chernecky CC, Berger BJ. Thoracentesis - diagnostic. In: Chernecky CC, Berger BJ, eds. Laboratory Tests and Diagnostic Procedures. 6th ed. St Louis, MO: Elsevier Saunders; 2013:1068-1070. Version InfoLast reviewed on: 8/3/2020 Reviewed by: Denis Hadjiliadis, MD, MHS, Paul F. Harron Jr. Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Last Reviewed: December 16, 2021 What is it?A thoracentesis is a procedure that removes fluid from the pleural space. The pleural space is the space between the lungs and the chest wall. It is normal to have a small amount of fluid in this space (about four teaspoons). Too much pleural fluid is called a pleural effusion. As the amount of fluid increases, it becomes hard to breathe since the fluid causes too much pressure on the lungs. There are two reasons that a thoracentesis might be done:
A pleural effusion is diagnosed based on your medical history, your physical exam, and diagnostic testing. Symptoms can include new or worsening shortness of breath and coughing. Medical history that can be linked to a pleural effusion include a history of smoking, heart disease, cancer, or exposure to tuberculosis or asbestos. When your provider listens to your lungs, they may sound muffled or have areas where no breaths can be heard. You may have an x-ray, ultrasound, or CT scan of your chest, all of which will show a buildup of fluid. Once your thoracentesis is done and the fluid has been tested (if needed), your provider will let you know about the follow-up plan and further treatment options. If it is thought that the excess fluid will continue to build up, your provider may suggest that a catheter be inserted to allow the fluid to be drained every so often. Speak with your provider about any concerns regarding your plan of care. How is it done?A thoracentesis can be done either in a provider’s office or in the hospital. Your provider will explain the procedure to you and have you sign a consent form. Tell your provider of any medications you are taking, any bleeding disorders you have, any allergies, or if you may be pregnant. The procedure often takes 10-15 minutes, but can take longer depending on the amount of fluid being removed. You will be awake for the procedure. You should not have much discomfort. You may be asked to put on a hospital gown. You may be given pain and/or anti-anxiety medications prior to the procedure if needed. You will want to use the bathroom prior to the procedure starting since you will be asked not to move once the procedure starts.
What are the risks?As with any procedure, there are risks associated with having a thoracentesis. These risks include pneumothorax (collapsed lung), respiratory distress, pain, bleeding, infection, and bruising. A pneumothorax is a side effect where air collects in the pleural space. The air can enter the pleural space through the needle used to remove the fluid, or the needle may puncture the lung allowing air to enter the space. In most cases, a hole in the lung will seal itself, but if enough air gets into the pleural space the lung can collapse. If the lung collapses, you may need to have a tube placed in the chest to remove the air. You may also have pain, bleeding, infection, and bruising at the insertion site of the needle. Pain may be managed with medication and changes in your positioning. It is important to keep the site clean and dry until healed. Bleeding at the insertion site will be managed by applying pressure. It is rare for bleeding to occur in or around the lungs, but if this happens your provider may need to place a tube in your chest to drain this blood. If the area looks or feels infected (redness, tender or sore, pus or drainage), call your provider. Infection can be treated with antibiotics. When should I call my care team?It is important to call your care team with any changes after your thoracentesis including fever, new or worsening shortness of breath, chest pain, uncontrolled pain or bleeding, foul-smelling discharge, or redness and warmth at the insertion site. Do they put you to sleep for thoracentesis?You will be in a sitting position in a hospital bed. Your arms will be resting on an over-bed table. This position helps to spread out the spaces between the ribs, where the needle is inserted. If you are not able to sit, you may lie on your side on the edge of the bed.
How painful is a thoracentesis?You will feel a stinging sensation when the local anesthetic is injected. You may feel pain or pressure when the needle is inserted into the pleural space. Tell your provider if you feel short of breath or have chest pain, during or after the procedure.
How long does thoracentesis procedure take?The procedure will take about 15 minutes. Most people go home shortly after. You can go back to work or your normal activities as soon as you feel up to it. If the doctor sends the fluid to a lab for testing, it usually takes a few hours to get the results.
Is thoracentesis considered major surgery?Thoracentesis is usually considered a minimally invasive surgery, which means it does not involve any major surgical cuts or incisions and is typically performed under local anesthesia. It is a procedure to remove fluid from the space between the lungs and chest wall or pleural space.
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