Thoracentesis at the Bedside
In inpatient and outpatient care, healthcare professionals encounter patients with varying needs. Regardless of the situation, accurate diagnosis and treatment are critical. Jane Anderson is a 58-year old African American who has been in and out of Mercy Medical Center due to congestive heart failure. She was also recently diagnosed with abdominal infections. Lately, her conditions have worsened, and she presents herself with chest pain, rapid breathing, shortness of breath, and intense fever. Since the signs and symptoms differ from what she usually experiences, nurses refer her for advanced tests for pleural effusion. Two tests, a chest CT scan and magnetic resonance imaging (MRI) scan, confirm pleural effusion. Jane’s personal physician recommends an immediate thoracentesis to remove the pleural fluid. The purpose of this paper is to describe how thoracentesis at the bedside works, its risks and benefits, and the interdisciplinary team’s roles and responsibilities. It will also describe nurses’ knowledge and skills required to provide care and patient education considerations.
Explanation and Background
Breathing problems and chest pains make patients uncomfortable and care provision challenging. The situation is more challenging for patients with pleural effusion co-occurring with other conditions like Jane Anderson. Wiederhold et al. (2021) described thoracentesis as a minimally invasive procedure for diagnosing and treating pleural effusions. To diagnose pleural effusions, the procedure helps determine the cause to guide further treatment. Removing the fluid or the air eases pain and breathing complications (Wiederhold et al., 2021). When performing thoracentesis, the responsible health care professional inserts a needle through the chest wall into the pleural space, the area with a small amount of fluid. The presence of excess fluid is the genesis of breathing problems since it prevents the pleura from rubbing together. The lungs cannot inflate completely, implying shortness of breath, discomfort, pain, and other complications due to limited physical activity.
Regarding the patient population, thoracentesis is typically for patients requiring inpatient care. They include adults with congestive heart failure (CHF), tuberculosis, pneumonia, and pulmonary embolism. Medications recommended after the procedure are primarily for easing pain and preventing pneumothorax, the commonest complication after thoracentesis (Shechtman et al., 2020). Safety should be a priority to prevent complications and exposure to other infections and injuries. Patients are advised to avoid intensive physical activities and habits that complicate breathing, such as smoking. Cost considerations include the expensive nature of the procedure since it can go as high as $1,500. Despite the challenges and excessive caution, the treatment modality is effective overall.
Risks and Benefits
Many treatment modalities for critical body organs are risky, particularly when they alter human functionality after a procedure. In most cases, procedures associated with skin penetration involve some infection risks. As a result, many patients require antibiotics after thoracentesis. Shechtman et al. (2020) found that partial collapse of the lungs (pneumothorax) is common after air enters the pleural space. Other risks include breathing problems and bleeding. Safety should be prioritized since removing too much fluid rapidly can cause pulmonary edema. Such risks increase morbidity, mortality, and overall health care cost. A suitable example of the effects of the risks is extended hospital stays due to iatrogenic pneumothorax (up to 4 days), increasing costs significantly (Hallifax et al., 2020). Caution at all levels is necessary.
Health care professionals propose a treatment modality based on its effectiveness. Thoracentesis has many benefits. Firstly, it is not a complex process; a patient can go through it and go home the same day. Secondly, thoracentesis is safe; morbidity and mortality chances are extremely low (Shechtman et al., 2020). Thirdly, thoracentesis helps to relieve pain and pressure on vital organs such as the lungs and treat breathing complications. The other crucial benefit of the procedure is helping health care professionals to determine the cause of pleural fluid to guide evidence-based interventions.
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Interdisciplinary Team’s Roles and Responsibilities
Thoracentesis at the bedside requires teamwork, active communication, and an in-depth understanding of patient needs. The interdisciplinary team’s roles and responsibilities differ depending on the condition and personal needs. Team-based care involves specialists such as pulmonologists and imaging experts, interventional radiologists, and physicians. The primary role of the experts is to ensure comprehensive diagnosis and treatment and recommend procedures and surgery as the patient’s condition obliges. Physicians interpret results and guide inpatient and home-based care.
Nurses play a critical role as members of the interdisciplinary team caring for the patient. Nurses make clinical rounds together with nurse leaders and other professionals, observe patients’ progress, and recommend specialized care if needed. They also help develop patient care plans and guide culturally-sensitive care (Brooks et al., 2019). However, working with an interdisciplinary team has some challenges. It requires different professionals to address a single case simultaneously, which is challenging since they are occupied differently. They also use different tools to examine patients and interpret situations differently. Streamlining the healthcare process may take more time as the interdisciplinary team members consult each other, leading to patient care delays.
Nursing Scope of Practice
Nurses’ knowledge and skills are critical for successful thoracentesis. Regarding knowledge, registered nurses (RNs) must understand when thoracentesis is necessary, the signs and symptoms, and the cause of the pleural effusion. Vital skills include performing and interpreting chest x-rays, placing patients on the examining table or bed, sterilizing the body areas where the needle will be inserted, and preventing skin infections through a surgical drape. The immediate pain can also be prevented by numbing the insertion area with a local anesthetic. A positive attitude towards thoracentesis is crucial to encourage patients and support them throughout the process. RNs should perceive thoracentesis as a less risky treatment modality, vital in preventing and treating breathing complications and chest pains.
Patients and their families need adequate information on treatment modalities to prevent ethical and legal issues. Adequate knowledge of healthcare procedures also increases confidence in the process and trust in healthcare providers. As a result, patients and their families should be informed about what to expect during and after the procedure. They should also be adequately informed about its risks and benefits. Cultural considerations include patients’ and families’ perceptions of modern practice and complex procedures and language barriers. Nurses must ensure that patients understand everything in detail. They should also ensure that the healthcare delivery is patient-centered by applying the nursing process framework (Harding et al., 2020). A language interpreter should be sought in case of language barriers. The effectiveness of the teaching can be evaluated by analyzing patients’ confidence levels and willingness to collaborate as advised. They should also answer questions about the procedure, risks, and benefits correctly.
Treatment modalities have improved over time to enable healthcare professionals to deal with complex health problems such as pleural effusions effectively. Thoracentesis at the bedside is an effective treatment modality for diagnosing and treating breathing problems and chest pains. As explained in this paper, nurses’ role is critical as members of the interdisciplinary team. They ensure that patients and families understand the procedure and are confident in it. Resources for further learning include radiologyinfo.org for patients and Johns Hopkins medicine factsheets on thoracentesis.
Brooks, L. A., Manias, E., & Bloomer, M. J. (2019). Culturally sensitive communication in healthcare: A concept analysis. Collegian, 26(3), 383-391. https://doi.org/10.1016/j.colegn.2018.09.007
Hallifax, R. J., McKeown, E., Sivakumar, P., Fairbairn, I., Peter, C., Leitch, A., …&Rahman, N. M. (2020). Ambulatory management of primary spontaneous pneumothorax: an open-label,randomised controlled trial. The Lancet, 396(10243), 39-49.https://doi.org/10.1016/S0140-6736(20)31043-6
Harding, M. M., Kwong, J., Roberts, D., Reinisch, C., &Hagler, D. (2020).Lewis’s Medical-Surgical Nursing: Assessment and management of clinical problems (11th ed.).Elsevier.
Shechtman, L., Shrem, M., Kleinbaum, Y., Bornstein, G., Gilad, L., & Grossman, C. (2020).Incidence and risk factors of pneumothorax following pre-procedural ultrasound-guided thoracentesis. Journal of Thoracic Disease, 12(3), 942-948.https://dx.doi.org/10.21037%2Fjtd.2019.12.39
Wiederhold, B. D., Amr, O., Modi, P., & O’Rourke, M. C. (2021).Thoracentesis.StatPearls [Internet]. StatPearls Publishing.https://www.ncbi.nlm.nih.gov/books/NBK441866/