3 Pleural Effusion-Definition it is an abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption.It is the most common manifestation of pleural disease, with etiologies ranging from cardiopulmonary disorders to symptomatic inflammatory or malignant diseases.
4 Pleural EffusionThe prevalence of pleural effusion is slightly in excess of 400/ population.Approximately 1.5 million pleural effusions are diagnosed in the United States each year.
29 Pleural Effusion-Treatment Treat the causeDiureticsAntibioticsAlbuminCorticosteroidsAnti-inflammatory agentsImmunosuppressants
30 Treat the cause Malignancy Infection Trauma Pulmonary infarction & EmbolismPancreatitisRheumatoid PleurisyTuberculosis
31 Treat the cause Congestive Heart Failure (CHF) Cirrhosis HypoproteinemiaNephrotic syndromeMyxedema
32 ThoracocentesisFrom Greek, thorax + centesis, puncture) also known as pleural tap,It is an invasive procedure to remove fluid or air from the pleural space for diagnostic or therapeutic purposes. A cannula, or hollow needle, is carefully introduced into the thorax, generally after administration of local anesthesia. The procedure was first described in 1852.The recommended location varies.midaxillary line, in the eighth, ninth, or tenth intercostal space.Whenever possible, the procedure should be performed under ultrasound guidance, which has shown to reduce complications.
35 Precautions-thoracocentesis Pain freeProper position and postureSelection of exact location to be puncturedBleeding profileAmount of fluid to be taken outPost procedure precautions
36 Thoracocentesis Contraindications An uncooperative patient Coagulation disorderRelative contraindications include cases in which the site of insertion has known emphysemaPatient is on mechanical ventilationOnly one functioning lung
37 Thoracocentesis Complications Pneumothorax Hemothorax Hemopneumothorax HypotensionPulmonary edemaMinor complications include:A dry tap (no fluid return)Subcutaneous hematoma or seromaAnxiety, Dyspnea and coughThe use of ultrasound for needle guidance can minimize the complication rate.