Common indications

Thoracentesis is performed to sample or remove fluid that is in the pleural space for both diagnostic and therapeutic purposes. Fluid removed from the chest cavity should be evaluated with red and white cell counts, Gram stains, cultures, chemical markers such as lactate dehydrogenase (also referred to as LDH), protein, and glucose, and cytology studies.

Equipment

A thoracentesis tray contains Betadine for cleansing the skin, a fenestrated drape, a local anesthetic, a syringe for the local block and a larger syringe for fluid aspiration, a thoracentesis catheter or trocar, and tubing to connect to a drainage system (Figure 37-1A). Have vacuum bottles or a collection bag available to allow for the drainage of pleural fluid. There are many variations of the kits available, but the two basic catheters are the catheter-over-needle systems and the needle-over-catheter systems. In this case, a needle-over-catheter system is used. In either system, after the needle has been pulled back from the tip of the catheter following insertion into the patient, never re-advance the needle forward or retract the catheter if the needle is still in the patient (Figure 37-1B). This maneuver can shear off the tip of the catheter into the patient’s pleural cavity, leaving a foreign body in place that would be difficult to remove.

FIGURE 37-1 A. Thoracentesis tray. B. Shearing the catheter in a needle-over-catheter system.

Key steps

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