Thoracic puncture

Many people do not have a particular understanding of thoracic puncture, which is a common treatment method in clinical pulmonology. It can clarify the nature of pleural effusion in patients, and also play a good therapeutic role in cases where a large amount of effusion causes lung compression. It is a convenient and simple treatment and diagnostic method. Below, we will briefly understand what thoracic puncture is, its indications, and the process of puncture.

What is thoracic puncture?

In clinical pulmonology, thoracic puncture is a common, convenient, and simple diagnostic and treatment method. For example, through examination, we find that there is effusion in the pleural cavity of the patient. We can extract the fluid through thoracic puncture for various examinations to find the cause of the disease. If there is a lot of effusion in the cavity, compressing the lungs or the effusion lasting for a long time, the fibrin in it is easy to be organized and cause adhesion of the two pleural membranes, thus affecting the lung respiratory function. At this time, we also need to puncture and aspirate the effusion. Drugs can also be injected into the cavity for therapeutic purposes when necessary.

Indications

To clarify the nature of pleural effusion, thoracic puncture aspiration is needed for diagnosis; for patients with a large amount of effusion or pneumatosis causing lung compression symptoms, as well as patients with empyema who need aspiration for treatment; drugs must be injected into the pleural cavity.

The whole process

1. Ask the patient to sit facing the back of the chair, with both forearms resting on the back of the chair and the forehead resting on the forearms. For patients who cannot get up, they can take a semi-sitting position with the affected forearm raised and held against the pillow.

2. Select the puncture site at the most prominent percussion area of the chest. When there is a large amount of effusion, the scapular line or posterior axillary line at the 7th to 8th intercostal space is usually chosen; sometimes the 6th to 7th intercostal space of the axillary midline or the 5th intercostal space of the anterior axillary line is also selected as the puncture site. Encapsulated effusion can be determined by combining X-ray or ultrasound examination, and the puncture site is marked on the skin with a cotton swab dipped in methyl violet (gentian violet).

3. Routinely disinfect the skin, wear sterile gloves, and cover with a sterile drape.

4. Use 2% lidocaine to perform local infiltration anesthesia from the skin to the parietal pleura at the puncture site on the upper edge of the next rib.

5. The operator fixes the skin at the puncture site with the left index finger and middle finger, turns the three-way cock of the puncture needle to the closed position with the pleural cavity, and slowly inserts the puncture needle at the anesthetized site. When the resistance suddenly disappears, turn the three-way cock to communicate with the pleural cavity for aspiration. The assistant uses a hemostatic forceps to help fix the puncture needle to prevent it from penetrating too deeply and injuring the lung tissue. After the syringe is full, turn the three-way cock to communicate with the outside world to discharge the liquid.

6. After aspiration, remove the puncture needle, cover with sterile gauze, apply slight pressure for a moment, and ask the patient to lie still after fixing with adhesive tape.