内視鏡検査 II: 胸腔穿刺

Thoracocentesis, also called pleural tap, involves inserting a needle into the pleural space between the lung and chest wall under local anesthesia. It serves both diagnostic and therapeutic purposes: diagnostically, it analyzes pleural fluid to identify infection, trauma, or cancer; therapeutically, it relieves respiratory distress by removing excess fluid or air from the pleural cavity.

The patient is typically positioned upright with elbows resting on an overbed table and feet supported on a stool or chair. This position expands the chest cavity and provides access to the pleural space. Alternatively, the patient may be positioned on their unaffected side in a side-lying position, depending on clinical circumstances and physician preference.

Pleural fluid analysis includes culture and sensitivity, differential cell count, cytology, pH, total protein, lactic dehydrogenase, glucose, amylase, triglycerides, and cancer markers such as carcinoembryonic antigen. These tests aid in diagnosing infection, trauma, cancer, inflammatory diseases, and heart failure by revealing the fluid's composition and characteristics.

Post-procedure complications include respiratory distress, dyspnea, tachypnea, hypotension, increased respiratory rate, asymmetrical breathing, syncope or vertigo, chest tightness, uncontrolled cough, blood-tinged or frothy mucus, tachycardia, and hypoxemia. Nurses must monitor vital signs closely and watch for pneumothorax, a collapsed lung that may require chest radiography to confirm.

Nurses must explain the procedure and obtain informed consent, assist with proper patient positioning, maintain aseptic technique throughout, monitor vital signs including pulse oximetry, observe for complications during fluid removal, apply a sterile pressure dressing post-procedure, and position the patient on the unaffected side for at least one hour to promote comfort and prevent complications.

After thoracocentesis, apply a sterile pressure dressing to the puncture site and reposition the patient on the unaffected side for at least one hour. Ensure chest radiography is completed to rule out pneumothorax or other complications. Document the amount, color, and characteristics of fluid removed, and continue monitoring vital signs and respiratory status for signs of delayed complications.

Unlike endoscopic studies such as bronchoscopy and thoracoscopy that visualize airways and pleural surfaces, thoracocentesis directly samples pleural fluid for laboratory analysis. This allows identification of specific pathogens, cell types, and chemical markers. While other diagnostic methods provide imaging or visualization, thoracocentesis provides direct fluid analysis for definitive diagnosis of pleural space disorders.