Thoracentesis is usually considered a minimally invasive surgery, which means it does not involve any major surgical cuts or incisions and is typically performed under local anesthesia. It is a procedure to remove fluid from the space between the lungs and chest wall or pleural space.
- The doctor will inject a local anesthetic (numbing medicine) into the area.
- When the area is numb, the doctor will put a needle in the space between the backside of the ribs.
- The patient may feel some pressure where the needle goes in. The doctor will slowly withdraw the fluid into the needle.
- The doctor will ask the patient to hold still, breathe out deeply, or hold their breath at certain times during the procedure.
- In thoracentesis, the doctor inserts a needle camera (and sometimes a plastic catheter) through the chest wall.
- The doctor often uses ultrasound pictures to help them guide the placement of the needle.
- Once the doctor removes the fluid from the pleural space, they may send it to a lab to determine what is causing the fluid buildup in the pleural space.
- If the doctor performs thoracentesis as a diagnostic procedure, then they may remove 20-100 mL of the fluid.
- For therapeutic purposes, removing 400-500 mL of the pleural fluid is often sufficient to reduce shortness of breath.
- The usual recommended limit is 1,000-1,500 mL in a single thoracentesis procedure.
- Depending on the volume of fluid in the pleural space, this procedure generally takes 10-15 minutes to complete. In rare cases, the procedure may last more than 30 minutes.
Through lab (histopathological) examination of the collected fluid, the doctor may try to pinpoint the cause of the pleural buildup such as mesothelioma (a type of cancer), lung infection, congestive heart failure, or kidney/liver disease. Knowing the cause of the fluid buildup can help doctor provide definitive treatment to the patient.
Why do I require thoracentesis?
A patient may require thoracentesis to remove the excess fluid from the space between their lungs and chest wall (pleural space). This provides relief from the associated symptoms such as shortness of breath and chest discomfort.
Thoracentesis is a procedure to remove fluid or air from around the lungs. The patient may be having excess fluid or air in the chest cavity. When this occurs, it’s harder to breathe because their lungs can’t inflate fully. This can cause shortness of breath and pain. These symptoms may worsen with physical activity. Thoracentesis can also help diagnose health problems such as:
- Pleural effusion (excess fluid in the chest cavity)
- Congestive heart failure (CHF) (a condition of the heart muscle when it cannot pump sufficient blood for the functioning of the body)
- Viral, fungal, or bacterial infections
- Systemic lupus erythematosus (SLE) and other autoimmune diseases
- Pancreatitis (inflammation of the pancreas)
- Pulmonary embolism (a blood clot in the lungs)
- Empyema (collection of pus in the pleural space)
- Liver failure
- Tuberculosis (TB)
- Reactions to medicines
What are the possible risks of thoracentesis?
Thoracentesis is usually very safe, offering more benefits than risks. In general, some potential risks include the following:
- Complete or partial collapse of the lung can occur if the lung is accidentally punctured by the needle during treatment
- Pulmonary edema (excess fluid in the lungs) occurs most commonly if too much fluid is removed from the pleural space
- Damage to the liver or spleen if the needle isn’t properly placed (rare)
- Bleeding (if the needle punctures one of the arteries or veins that run along the ribs)
- Side effects of anesthesia such as allergy
- Postoperative pain
- Postoperative infection
Patients with a history of a lung surgery face higher risks, as do patients with severe, irreversible lung disease such as asthma or emphysema. Patients with any condition that affects normal blood clotting may also face a higher risk of bleeding.