Thoracentesis and paracentesis: preparation and monitoring
Both are drainage punctures of a cavity and both share the same nursing logic: position, coagulation, volume removed, and the surveillance that follows. Before: verify the platelet count and the coagulation profile, and the anticoagulation plan. Confirm the consent and that the side has been identified and marked for the thoracentesis. Have the client empty the bladder before a paracentesis, since the bladder sits in the needle path. Position for a thoracentesis: seated leaning forward over a bedside table, arms supported. The client must stay still and not cough during the needle insertion; explaining this before rather than during is what makes it possible. After a thoracentesis: the complication to watch for is pneumothorax. Sudden dyspnea, chest pain, absent breath sounds on the punctured side, falling saturation. A chest radiograph is often ordered afterwards. After a paracentesis: the complication to watch for is hypotension from the fluid shift when a large volume has been removed. Take the blood pressure lying and sitting, monitor for dizziness, and watch the puncture site for leaking. In both cases, record the volume and the appearance of the fluid drained and send the specimens as ordered.