NURSING PATIENT CARE POLICY & PROCEDURE
February 28, 2017
Nursing Manual (Red)
Policy #: 11.22A
Title: Thoracentesis or Chest Aspiration
To provide guidance for the registered nurse (RN) when assisting the provider with
withdrawal of fluid from the pleural space.
Procedure will be performed by the provider who will indicate the purpose of the
A. Sterile disposable thoracentesis set with catheter (Central Service [CS] Item
B. Sterile gloves
C. Sterile towels and drape sheet
D. #11 scalpel blade
E. 4x4 sterile gauze sponges
F. Medication, if ordered, for intrathoracic instillation and moderate sedation
G. Protective apparel as indicated
H. Laboratory requisitions, as appropriate
I. Evacuated container bottles (CS Item Number 9996054 for 1,000 mL, or 9996160
for 500 mL)
J. Culture bottles, as ordered
K. PICO syringe, as ordered (CS Item Number 2227067)
L. Patient label and lab requisition form
M. Resuscitative and monitoring equipment according to UWHC Administrative
Policy 8.38, UWHC Adult Sedation Policy (section IV, A, 3).
A. Pre Procedure
1. Verify orders for procedure and consent has been obtained. Verify
orders for procedure and medication orders if used. Order set 2471 (IP-
2. Perform hand hygiene according to UWHC Administrative Policy
13.08, Hand Hygiene.
3. Follow standard and transmission based precautions according to
UWHC Administrative Policy 13.07, Standard Precautions &
Transmission-based Precautions (Isolation) for Inpatient Settings.
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B. Verify the need for venous access.
C. For all procedures requiring sedation please refer to UWHC Administrative
Policy 8.38, Adult Sedation. Moderate Sedation will be documented using the
Sedation Navigator within the electronic health record.
D. Complete universal protocol (to prevent wrong patient, site and procedure)
must be performed and documented consistent with UWHC Administrative
Policy 8.48, Operative, Invasive & Other Procedures.
E. Assess baseline patient condition, vital signs, and breath sounds.
1. Positioning the patient.
a. The preferred position is sitting with arms and head resting on
a pillow on the overbed table. Patient's position is determined
by location of fluid in the pleural cavity and patient condition.
b. If patient is unable to sit, position patient on his or her side
with the unaffected side down and have patient near the edge
of the bed. The arm on the affected side positioned above the
head. Elevate the head of bed 30-45 degrees, as tolerated, this
will help spread the ribs for easier access and lower the
diaphragm to reduce risk entering the abdominal cavity. The
RN may assist in holding the patient in this position.
c. Support patient to maintain the desired position while the
provider performs procedure. Any sudden or unexpected
movement by patient could cause trauma to the visceral pleura,
which could in turn cause trauma to the lung.
2. Observe patient, as removal of large amounts of fluid at one time may
cause patient to demonstrate symptoms of hypovolemia, such as
diaphoresis, dizziness or fainting, tachycardia, and hypotension.
Monitor pulse oximetry for signs of hypoxia.
Transfer specimens to appropriate collection bottles and label
specimens at bedside per UW Health Clinical Policy 2.5.1, Use of
Containers for Clinical Specimens. Send or hand-deliver appropriately
identified and labeled specimens immediately to Core Laboratory with
G. Post Procedure
a. Observe patient closely post-procedure (every 15 minutes x 2,
then every 30 minutes x 2, unless otherwise ordered by
b. Auscultate breath sounds at completion of procedure. Monitor
for tracheal deviation.
c. Report pain not controlled with ordered interventions,
increased respiratory rate, tracheal deviation, decreased breath
sounds, cough, hemoptysis, changes in vital signs, level of
consciousness, and change in dressing/puncture site to the
a. Monitor the dressing from drainage or bleeding following the
b. Apply a wound dressing, according to provider order.
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3. If moderate sedation is used, follow post procedure monitoring until
all criteria have been met for Phase I and Phase II. If no moderate
sedation, monitor patient until cleared by the provider staff.
4. If patient is to return home after the procedure, provide post procedure
education on monitoring respiratory effort, shortness of breath,
inability to catch their breath.
5. Dispose of drainage bags or evacuated bottles with fluid according to
UW Health Hazardous Material & Waste Management Plan.
6. Record the following in the patient’s clinical record:
a. Date/time procedure was performed
b. Name of provider
c. Amount, color and consistency of fluid withdrawn
d. Disposition of specimen(s)
e. Patient's tolerance of the procedure
V. UWHC CROSS REFERENCES
A. Health Facts For You (HFFY) 6430, Thoracentesis in Ultrasound
B. UW Health Hazardous Material & Waste Management Plan
C. UWHC Administrative Policy 8.38, UWHC Adult Sedation Policy
D. UWHC Administrative Policy 8.48, Operative, Invasive & Other Procedures
E. UWHC Administrative Policy 13.07, Standard Precautions & Transmission-based
Precautions (Isolation) for Inpatient Settings
F. UWHC Administrative Policy 13.08, Hand Hygiene
G. UW Health Clinical Policy 2.5.1, Use of Containers for Specimens
H. UWHC Clinical Laboratories Policy 1502.5.06 Acceptance Policy for Specimen
I. Nursing Patient Care Policy 7.12AP, Closed Chest Tube Drainage System (Adult
Lynn-McHale Wiegand, D. J. (Ed.)(2011). AACN Procedure Manual for Critical
Ed.). St. Louis, MO: Elsevier Saunders.
Rushing, J. (2006). Assisting with thoracentesis. Nursing, 36,12, 18.
Ritchie, M., Brown, C., and Bowling, M. (2017). Chest Tubes: Indications, Sizing,
Placement, and Management. Clinical Pulmonary Medicine, 24,1, Ipg. 37-53, doi:
VII. REVIEWED BY
Clinical Nurse Specialist, Cardiac Surgery
Clinical Nurse Specialist, Thoracic
Clinical Nurse Specialist, Medical Progressive Care Unit
Nursing Patient Care Policy and Procedure Committee, February 2017
Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive