Pleural puncture is the puncture of the chest wall and the membrane covering the lungs (pleura), which is produced for diagnostic or therapeutic purposes. This is a simple intervention on the chest, which in some cases allows saving the life of the patient.
Indications for puncture of the pleural cavity
The main indication for pleural puncture is the suspicion of the presence in the pleural cavity of air or liquid (blood, exudate, transudate). This manipulation may be required in such conditions and diseases:
- exudative pleurisy ;
- empyema of the pleura;
- hemothorax;
- chylothorax;
- hydrothorax;
- pneumothorax (spontaneous or traumatic);
- swelling of the pleura.
The contents of the pleural cavity obtained by puncture are used for diagnostic purposes for bacteriological, cytological and physico-chemical analyzes.
For therapeutic purposes, using the pleural puncture, the contents of the pleural cavity are aspirated and washed. Also in the pleural cavity may be administered various medications: antibiotics, antiseptics, proteolytic enzymes, hormonal, antineoplastic agents, etc.
Preparing for pleural puncture
On the day of the manipulation, other medical and diagnostic measures are canceled, as well as the taking of medications (except for the vital ones). Also physical and neuropsychic loads should be excluded, smoking is banned. Before the puncture, the bladder and intestine should be emptied.
Technique of pleural puncture
For pleural puncture a needle with a blunt cut is used, hermetically connected by a rubber adapter with a system for pumping out the liquid.
- Manipulation is carried out in the position of the patient sitting on a chair facing back. The head and trunk should be tilted forward, and the hand is taken over the head (to expand the intercostal spaces) or lean against the back of the chair. The puncture site is treated with alcohol and iodine solution. Then carry out local anesthesia - usually a solution of novocaine.
- The puncture site depends on its purpose. If it is necessary to remove air (pleural cavity puncture with pneumothorax), the puncture is performed in the third to fourth intercostal space in the anterior or middle axillary line. In the case of fluid removal (puncture of the pleural cavity with hydrothorax), a puncture occurs in the sixth to seventh intercostal space along the middle or posterior axillary line. The needle is connected to the syringe with a rubber tube. Pumping of the contents of the pleural cavity is carried out slowly to exclude the displacement of the mediastinum.
- The puncture site is treated with iodonate and alcohol, after which a sterile napkin is applied and fixed with adhesive plaster. Next, a tight bandage of the chest sheet is made. The material obtained at the puncture should be delivered to the laboratory for examination no later than in an hour.
- The patient is delivered to the ward on a gurney in a lying position. During the day he is ensured bed rest and is monitored for the general condition.
Complications of pleural puncture
When performing pleural function, the following complications are possible:
- puncture of the lung, diaphragm, stomach, liver, spleen;
- intrapleural bleeding;
- air embolism of cerebral vessels;
- bleeding from the puncture site.
In case of any complication, it is required to immediately remove the needle from the pleural cavity, place the patient on the back and call the surgeon. With air embolism of the cerebral vessels, the neuropathologist and resuscitator need help.