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Thoracentesis by Amanda L. Dameron, MA

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

Definition

A pleural effusion is a build-up of fluid in the space between the lungs and the chest wall. This space is called the pleural space. Thoracentesis is a procedure to remove fluid from this area.

There are two types of thoracentesis:

Therapeutic thoracentesis—to relieve the symptoms of fluid accumulation
Diagnostic thoracentesis—to test for the cause of the fluid build-up

Reasons for Procedure

There is always a small amount of fluid in the pleural space. The fluid helps to lubricate the area. When too much fluid builds up in this space, it can make it difficult to breathe.

Your doctor may want to test some of the fluid after removing it. The build-up of fluid can be a symptom of diseases or disorders, such as:

Congestive heart failure (CHF)
Lung infections
Kidney disease
Pulmonary embolism —a clot that travels to the lung
Cancer
Liver disease
Pancreatitis

Smoking may increase the risk of complications.

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have a thoracentesis, your doctor will review a list of possible complications, which may include:

A collapsed lung
Fluid building up again
Bleeding
Infection
Damage to the liver or spleen

Factors that may increase the risk of complications include:

A history of lung surgery
A long-term, irreversible lung disease, such as emphysema or asthma
Anything affecting normal blood clotting

What to Expect

Prior to Procedure

Your doctor may order:

A complete physical exam
X-ray
CT scan
Ultrasound
Blood tests

Anesthesia

A local anesthetic will be used. It will numb the area where the needle will be inserted.

Description of the Procedure

You may be asked to sit upright on the edge of a bed or chair. Your arms will be resting on a nearby table. If your procedure involves a CT scan, you may be asked to lie on a table. Try to avoid coughing, breathing deeply, or moving during the procedure.

A small patch of skin on your back, chest, or under your armpit will be sterilized. Anesthesia will be applied to this patch. It will help numb the area.

The doctor may use ultrasound or CT scan images. These images will help guide the needle and monitor the fluid. A needle or thin plastic catheter will be inserted between your ribs. The needle or catheter is then passed into the pleural space. Some or all of the fluid will be drawn into the syringe.

Placement of Thoracentesis Needle

How Long Will It Take?

About 15 minutes

Will It Hurt?

You may feel slight pain or a stinging when the needle is first inserted. As the fluid is being extracted, you may feel a sense of pulling. Tell your doctor or nurse if you feel extreme pain, any shortness of breath, or faint.

Post-procedure Care

At the Care Center

If the thoracentesis is being done for diagnostic reasons, the fluid will be sent to a lab for testing. Often, another chest x-ray will be done to ensure that the fluid has been removed and that there is no sign of a collapsed lung.

At Home

Keep the area of skin where the needle was inserted clean and dry. To help make your recovery smooth, be sure to follow your doctor's instructions .

If a diagnostic thoracentesis was done, ask your doctor when to expect the results.

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:

Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or any discharge from the insertion site
Pain that you cannot control with the medicines you have been given
Cough, shortness of breath, or chest pain
Coughing up blood
Pain when taking a deep breath

If you think you have an emergency, call for medical help right away.

RESOURCES:

American Lung Association http://www.lung.org
American Thoracic Society http://www.thoracic.org

CANADIAN RESOURCES:

The Canadian Institutes of Health Information http://www.cihi.ca
The Canadian Lung Association http://www.lung.ca

References:

Harrison’s Principles of Internal Medicine . 16th ed. McGraw-Hill; 2005.
Mason RJ. Murray & Nadel's Textbook of Respiratory Medicine . 4th ed. WB Saunders; 2005.
Roberts JR. Clinical Procedures in Emergency Medicine . 4th ed. WB Saunders; 2004.
What is thoracentesis? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/thor/ . Updated February 24, 2012. Accessed April 10, 2013.
6/3/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

Last reviewed March 2013 by Marcin Chwistek, MD

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