Nursing Care Plan for Thoracentesis (Procedure)

Pathophysiology

The purpose of a thoracentesis is to remove fluid or blood from around the lungs in the pleural space.  This could be due to a pleural effusion (a collection of pleural fluid, sometimes infectious, sometimes not), or due to a hemothorax.  Samples of this fluid could be sent for diagnostic testing and cultures if necessary. Removing this fluid allows for re-expansion of the lung and will help to alleviate symptoms for patients.

Etiology

Using ultrasound as a guide, the provider inserts a large needle through the space between the ribs into the pleural space to aspirate the fluid/blood. If this is only being done for sampling, a syringe of fluid will be collected and then the needle will be removed. If the goal is to drain a large volume of fluid (>100mL), then a catheter will be threaded over the needle and left in the pleural space. This will then be attached to a drainage bag or vacutainer bottle to allow slow drainage.  

Desired Outcome

Appropriate fluid will be collected and/or drained from the pleural space, allowing for full reexpansion of the lung and appropriate oxygenation. Possible complications such as pneumothorax, subcutaneous air, bleeding, and infection will be avoided.

Thoracentesis (Procedure) Nursing Care Plan

Subjective Data:

Indications

  • Dyspnea
  • Trouble catching breath
  • Chest tightness

 
Complications

  • Sudden, severe shortness of breath
  • Anxiety/restlessness
  • Pain at insertion site

Objective Data:

Indications

  • Diminished or absent breath sounds over the affected area
  • Evidence of fluid or blood collection on chest x-ray

 
Complications

  • Presence of subcutaneous air in skin around insertion site
  • Diminished or absent breath sounds
  • Bleeding from site
  • Fever, Increased WBC
  • Redness, swelling at site

Nursing Interventions and Rationales

  1. Ensure informed consent is obtained and the patient is educated about the procedure

  2. Informed consent should be obtained by the provider, including indications, risks, and possible complications of the procedure. You, the nurse, should simply ensure it is done and witness the patient’s signature.

  3. Ensure emergency equipment available at bedside

  4. As with any procedure involving the airway, emergency equipment should be kept ready at the bedside, including suction, ambu bag, and artificial/advanced airways in case of respiratory distress.

  5. Position patient on side of bed with arms and chest over bedside table

  6. This position helps to open the space between the ribs to allow for easier access to the location of the fluid or blood collection.

  7. Monitor Vital Signs, LOC, Respiratory status before, during, and after procedure per facility policy.

    • Obtaining a baseline assessment and set of vital signs helps to know if anything has changed during or after the procedure.  
    • Monitor VS during and after procedure per facility guidelines – being alert for possible respiratory distress.

  8. Administer analgesic, anxiolytic, or cough suppressant as ordered

  9. Patients are not sedated during this procedure, however it is imperative that they are calm and still during – this will help to prevent complications. We don’t want them squirming or coughing or they could end up with a punctured lung.

  10. Ensure strict sterile technique is maintained

  11. There is a high risk for infection, therefore it is imperative that you help keep the provider accountable to strict sterile technique. This also means that everyone in the room should have a mask and bonnet on.

  12. After procedure, position patient with good lung down and provide O2 as needed

  13. Good lung down positioning helps promote perfusion to the good lung and reinflation of the ‘bad lung’. Patients may require O2 as their lung reinflates and they recover.

  14. Label and send specimens to lab as appropriate

  15. Specimens should be labeled with the patient’s name/DOB/medical record number, plus your initials, date, and time. Many of these specimens should be hand-delivered to the lab to prevent damage or loss in a pneumatic tube system.

  16. Monitor for possible complications:

    • Pneumothorax
    • Subcutaneous Air
    • Bleeding
    • Infection
    • The needle could puncture the lung, causing a pneumothorax
    • If the pleural cavity is not closed properly, air can leak between the skin and the muscle – causing SubQ air
    • Bleeding at the site or bleeding internally (hemothorax) are both possible due to the invasiveness of the procedure
    • Strict sterile technique should be maintained – infection is possible as with any invasive procedure.

  17. Educate patient on signs and symptoms to report to provider.

  18. Patients should report sudden shortness of breath, chest pain, or s/s infection like fever/chills, pain at the insertion site.


References

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