Thoracentesis

This procedure may be done in your doctor’s office, an emergency room, the ultrasound department, or at your bedside in the hospital. You will need to take off the top of your clothing and be given a gown to use during the procedure. You will be asked to sign a consent form before a thoracentesis, which is a procedure to remove fluid from the pleural space.

A clinical staff member will bring you into the procedure area. Your doctor or mid-level provider will greet you, review the procedure, and answer any questions you may have. During the procedure, you will be seated but leaning forward on a padded bedside table with your arms resting on a table. Ultrasound will 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 or mid-level provider 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 or mid-level provider will insert the needle into the pleural space to remove the fluid.

You may feel some mild pain or pressure as the needle is inserted. A syringe or a small tube attached to a vacuum bottle is used to remove the pleural fluid. A large amount of fluid can be removed if the fluid is causing shortness of breath or chest pains. 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 outpatient procedure takes about 10 to 15 minutes.

There are things you can do to make your experience more comfortable, and many of these will depend on your individual preferences. You might like to keep a list of questions or—as you’re doing now—educate yourself about the procedure.

Another important part of your preparation will be guided by your doctor:

• Your doctor may ask you to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), or blood thinners (such as Coumadin, Warfarin, Plavix, Fragmin) for a time before the procedure.
• The day before the procedure (or the Friday before, if you’re scheduled for a Monday procedure), a clinical staff member from the Interventional Radiology Department will call you. The clinical staff member will give you any additional instructions and ask if you have any questions.
• Take your medications as instructed.
• When you arrive, make sure the clinical staff member and radiologist know about any allergies you may have, especially allergies to local anesthetics (such as lidocaine), general anesthetics, or X-ray dye (contrast media). If there’s any chance you might be pregnant, tell your radiologist.

• Wear comfortable, loose-fitting clothes.
• Wear comfortable shoes.
• Avoid bringing jewelry or valuables.
• Arrange for someone to drive you home after the procedure.

Thoracentesis is generally a safe procedure. A chest X-ray is usually done right after the procedure to make sure that no complications have occurred.

The benefits of Thoracentesis could be:

• Diagnose an infection in the pleural cavity, including viral, fungal, or bacterial infections.
• Remove a large amount of fluid that is causing pain or difficulty breathing.

Risks you should be aware of include:

• You can sustain a partial or complete collapse of the lung (pneumothorax).
• You can experience pulmonary edema, which may occur if a large amount of fluid is removed.
• There is always a small chance of bleeding and infection.
• There is a slight risk of fluid leaking at the needle site.
• You might feel short of breath or experience chest pains during the procedure.

Keep in mind that this information is general. Your radiologist is the best source of information about how these risks and benefits may apply to you.