Thoracentesis (updated 07/2018)

PROCEDURE: [Diagnostic and Therapeutic] Thoracentesis.
INDICATION: Large [XXXXX] pleural effusion with respiratory distress.
PROCEDURE OPERATOR: [XXXXX].
ATTENDING PHYSICIAN: [XXXXX]. [Present for the procedure].
PRE-PROCEDURE DIAGNOSIS: Large [XXXXX] pleural effusion with respiratory distress.
POST-PROCEDURE DIAGNOSIS: Large [XXXXX] pleural effusion status post drainage with improvement in respiratory distress.

CONSENT:
Consent was obtained from the patient. Indications, risks, and benefits were explained at length. All questions were answered.

PROCEDURE SUMMARY:

A time out was performed and the pre-procedure chest x-ray were reviewed in addition to our ultrasound findings. The [XXXXX] side was confirmed and marked.

[Patient sat upright in the bed and we used a posterior approach.]

The ultrasound was used at the bedside to verify there is a pleural effusion. 

The phased array probe was used to identify the deepest pocket, which was [7 cm] from the surface of the skin to the lung, at the level of approximately the [T5] interspace, and stayed away from the diaphragm after identifying the structure on ultrasound. We verified there were no obvious loculations with the phased array probe. [We were able to see consolidations in the lung.] 

The linear array probe was used to scan the subcutaneous fascia.  The subcutaneous fascia was found to be approximately [3 cm deep] and clearly marked the superior surface of the rib using ultrasound guidance for entry.  We did not note any vascular structures using the color doppler. 

My hands were washed immediately prior to the procedure. I wore a sterile gown and sterile gloves throughout the procedure. The patient was prepped and draped in a sterile manner using chlorhexidine scrub after the appropriate level was determined via ultrasound and marked (as seen above). 1% plain lidocaine was used to anesthetize the skin, subcutaneous tissue, superior aspect of the rib periosteum and parietal pleura; straw colored fluid was aspirated at a depth of approximately [3 cm] with the syringe used to anesthetize. A 11-blade scalpel was used to nick the skin at the insertion site. The thoracentesis needle was then introduced through the skin incision into the pleural space using negative aspiration pressure. The thoracentesis catheter was then threaded without difficulty. 1000 ml of straw colored fluid was removed without difficulty via manual syringe aspiration in a closed system. The catheter was then removed while the patient hummed. A pressure dressing was applied. 

No immediate complications were noted during the procedure. The patient tolerated the procedure well. 

A post-procedure chest x-ray is pending at the time of this note.

[The fluid will be sent for studies.]

Estimated blood loss: [2 mL]