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Thoracentesis

Thoracentesis is a procedure to remove fluid from the space between the lungs and the chest wall called the pleural space. It is done with a needle (and sometimes a plastic catheter) inserted through the chest wall. This pleural fluid may be sent to a lab to determine what may be causing the fluid to build up in the pleural space.

Normally only a small amount of pleural fluid is present in the pleural space. A buildup of excess pleural fluid (pleural effusion) may be caused by many conditions, such as infection, inflammation, heart failure, or cancer. If a large amount of fluid is present, it may be difficult to breathe. Fluid inside the pleural space may be found during a physical examination and is usually confirmed by a chest X-ray.

Your doctor may recommend a Thoracentesis to:

  • Find the cause of excess pleural fluid (pleural effusion)
  • Relieve shortness of breath and pain caused by a pleural effusion

You will be asked to sign a consent form before a thoracentesis. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. Tell your doctor if you are taking any medicine, are allergic to any medicines, including numbing medicines, and have had bleeding problems or are taking blood thinners such as aspirin. Also, certain conditions may increase the difficulty of thoracentesis.

Let your doctor know if you have:

  • Had lung surgery. The scarring from the first procedure may make it difficult to do this procedure.
  • A long-term (chronic), irreversible lung disease, such as emphysema.
  • A chest X-ray is usually done before the procedure. Your doctor may order certain blood tests, such as a complete blood count (CBC) and bleeding factors, before your procedure.

This procedure may be done in your doctor's office, in the X-ray department of a hospital, in an emergency room, or at your bedside in the hospital. Your doctor may have a nurse assist with the procedure. You will need to take off all or most of your clothes (you may be allowed to keep on your underwear if it does not interfere with the procedure). You will be given a cloth or paper covering to use during the procedure. During the procedure, you will be seated but leaning forward on a padded bedside table. If your test is done in the X-ray department, X-rays or an ultrasound may be used to confirm the location of fluid in your chest. The needle site between your ribs will be cleaned with an antiseptic solution. Your doctor will give you a local anesthetic in your chest wall so you won't feel any pain when the longer needle that withdraws the fluid is inserted. Once the area is numb, your doctor will insert the needle to where the fluid has collected (pleural space). You may feel some mild pain or pressure as the needle enters the pleural space.

A syringe or a small tube attached to a vacuum bottle is used to remove the pleural fluid. Your doctor collects 50ml to 100ml of fluid at a time to send to the lab. Up to 1500ml may be removed if the fluid is making it difficult for you to breathe. Once the fluid is removed, the needle or small tube is removed and a bandage is put on the site. An X-ray is usually taken right after the procedure to make sure that no complications have occurred. If more pleural fluid collects and needs to be removed, another Thoracentesis may be done later. This procedure takes about 10 to 15 minutes.

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