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A thoracentesis involves placing a needle or catheter (soft, flexible, rubber tube) into fluid in the chest cavity around the lung. Radiologists generally perform thoracenteses using ultrasound guidance – we use an ultrasound machine to watch as the needle is placed. This helps us ensure that the needle is placed in the correct spot and allows us to avoid important structures like the lung or blood vessels.
There are many reasons that fluid can accumulate in the chest cavity: heart failure, pneumonia, tumors and numerous others. Significant amounts of fluid can cause difficulty breathing by causing the lung to collapse and by pushing on the diaphragm. Thoracentesis allows us to remove fluid so the lung can expand and breathing difficulty can be relieved. The fluid can also be sent to the laboratory to be tested for signs of infection, tumor cells and other characteristics to help determine the cause of the fluid accumulation. Thoracentesis is often performed as an outpatient procedure.
Many members of Clinical Radiologists perform thoracenteses. We are experienced and highly skilled at these procedures, performing hundreds every year.
What preparation is needed for a thoracentesis?
The morning of the procedure you will report to the hospital registration desk and then proceed to the radiology department. Have someone with you who will be able to drive you home.
If your procedure is in the morning, you should not eat or drink after midnight the night before the procedure. You may, however, take your medicines in the morning with a small amount of water. If your procedure is in the afternoon, you may have a light breakfast. If you are diabetic, check with the Radiology Department or your personal physician for additional instructions about diet and medications. If you are on blood thinners, check with your physician for instructions.
What happens during the procedure?
You will generally be seated upright for the procedure. An ultrasound technologist will perform an ultrasound of your chest, usually scanning from the back, to document and evaluate fluid within the chest.
The radiologist will discuss the procedure and its risks prior to beginning the procedure. If you have any questions about the procedure, be sure to ask! Let the technologist or radiologist know if you have any family members you want to be present while the radiologist explains the procedure and answers any questions. Family members will not be able to watch the procedure.
The radiologist will clean your skin and numb the skin and chest wall. A needle will be placed through the numb area into the fluid. In most cases there will be a soft, flexible catheter on the outside of the needle. The radiologist slides the catheter off the needle and take the needle out; nothing sharp stays in the chest. After the fluid is removed, the catheter is taken out, the skin is cleansed and a band-aid is placed over the puncture site. You will be observed in the department for 15-20 minutes and then discharged if you are feeling well.
Most patients tolerate the procedure very well. In some cases, towards the end of the procedure, the catheter can rub on the inside of the chest lining and cause some pain or coughing. The pain or coughing generally resolves within about 5 minutes after the catheter is removed. Complications from thoracentesis are rare. Air may collect in the chest cavity after a thoracentesis, but this rarely requires treatment. Bleeding into the chest can occur and may result in chest pain, difficulty breathing or light-headedness which can require hospital admission and treatment. You will be given instructions regarding what to watch for and what to do if you experience any problems.
What about after the procedure?
You should generally take it easy for a few hours following the procedure. You may eat and drink after the procedure. The area of the procedure may be sore for one or two days after the procedure. Call the Radiology Department and ask to speak to a nurse or radiologist if you have any questions after leaving the department. You will be given additional discharge instructions prior to leaving.
If the fluid removed from the chest is sent for laboratory tests, the test results will be sent to your physician. Call your doctor’s office in two or three days for results unless other arrangements have been made.