What is a Thoracentesis?
A thoracentesis is a minimally invasive procedure performed to remove fluid from around the lungs. The lung space normally has a small amount of fluid between the lining, but certain conditions, such as pneumonia, cancer or heart failure can cause an abnormal amount of fluid to be present. The excess fluid can cause shortness of breath or discomfort in your chest.
Causes for a Thoracentesis
Thoracentesis treats pleural effusion, or excess fluid in the space between your lungs and chest wall. If you have a pleural effusion, you will likely need a thoracentesis to determine the cause and relieve uncomfortable symptoms. Common reasons to have a thoracentesis done include:
- Possible infection of the lungs.
- Check for cancerous cells.
- Provide symptom relief, especially trouble breathing.
Heart failure is the most common cause of pleural effusion. Other underlying causes may include:
- Congestive heart failure.
- Cancer.
- Pneumonia.
- Lupus or other autoimmune diseases.
- Blood clots in your lungs.
- Pulmonary hypertension.
- Inflammation of the pancreas.
- Kidney or liver disease.
- Tuberculosis.
Risk Factors of a Thoracentesis
As with any procedure, there are certain risks associated with thoracentesis. However, a thoracentesis is a safe procedure, and the risk of complication is very low. Quitting smoking reduces your risk of complications. Possible complications can include:
- Bleeding.
- Infection.
- Collapsed lung.
- Pulmonary edema – occurs when the fluid around your lungs is removed too quickly, resulting in fluid buildup inside of your lungs instead.
Contact your provider if you experience any of the following:
- Fever.
- Redness, swelling or bleeding at the needle site.
- Chest pain or pain taking a deep breath.
- Coughing up blood.
- Sudden trouble breathing or shortness of breath.
What to Expect During a Thoracentesis
Prior to your procedure, your provider may instruct you to stop taking certain medications. You will need to arrange for someone to drive you home following the procedure. It is important to tell your provider if you have a blood clotting condition, take blood thinners or if you are pregnant or could be pregnant.
Your provider will perform a physical examination, including taking your blood pressure and measuring your blood oxygen levels. Then, they will use imaging tests to show where the fluid is and how much there is.
A thoracentesis is typically done in-office and should only take about 15 minutes. You may be asked not to move or to hold your breath at certain points during the procedure. Slight pressure or discomfort is normal but tell your provider if you experience sudden chest pain or feel short of breath.
Your skin will be numbed with a local anesthetic and a small cut will be made in the skin. A needle will be inserted between your ribs to take out the fluid, and a tube attached to the needle will drain the fluid. Once the fluid has been drained, the needle is removed, and pressure held on the site for a short time. Stiches are not necessary to close the site.
What to Expect After a Thoracentesis
Following your procedure, your provider may have you get an X-ray or ultrasound of your lungs to ensure there is no more fluid around them. You may cough for up to an hour after thoracentesis, which is normal and helps your lungs to expand again. The fluid that was removed will be sent to a lab to test for infectious diseases and to try to determine the cause of your pleural effusion.
Once test results have come back, your provider will review them with you and recommend any treatment options, if necessary. It is important to follow post-op instructions to avoid complications and manage symptoms or side effects you may experience, including pain, coughing or fluid leakage from the drainage site. You should be able to return to normal activities after 48 hours.
In some cases, fluid may return on the lungs due to an underlying medical condition. If this occurs, additional thoracentesis procedures may be needed. Your provider will work with you to determine the next step of treatment.