Thoracentesis

Thoracentesis is a procedure that takes fluid out from the area between your lungs and chest wall (pleural space).

A thin membrane lines both your lungs and chest wall. Fluid between these two layers helps them move smoothly past each other when your lungs expand as you breathe. Just like a hinge needs oil to help a door move smoothly, your lungs need pleural fluid to help you breathe.

Some medical conditions cause fluid to leak into your pleural space and make it hard to breathe. This is pleural effusion. If the size of the pleural effusion gets big enough, or if you develop symptoms like shortness of breath or cough, your provider may recommend thoracentesis. It’ll help make breathing more comfortable. It also allows your provider to figure out why fluid is building up.

Thoracentesis is common — more than 170,000 people in the U.S. get it each year. It’s also a minimally invasive procedure. That means your provider doesn’t make large incisions (cuts) to access your pleural space. You’ll recover faster, and there are fewer risks than with major surgeries.

Another name for thoracentesis is pleural tap.

Why would it be performed?

Thoracentesis treats pleural effusion. Congestive heart failure is one of the most common causes of pleural effusion. But many other underlying conditions may cause it, including:

• Cancer
• Pneumonia
• Autoimmune diseases, including lupus
• Blood clots in your lungs
• High blood pressure in the arteries that send blood from your heart to your lungs
• Pancreas inflammation
• Kidney or liver disease
• Tuberculosis (TB)

What happens before thoracentesis?

Before thoracentesis, your provider will explain the procedure to you. They’ll also give you specific instructions on how to prepare. These may include:

• Stop taking medications that increase your bleeding risk. These include antiplatelet agents like clopidogrel (Plavix®) and blood thinners like apixaban (Eliquis®) or rivaroxaban (Xarelto®). Don’t stop taking medications unless your provider tells you to. You should also tell them about any herbal medications you’re taking. Some can also increase your risk of bleeding.
• Arrange for someone to take you home afterward.
• Wear loose, comfortable clothing so you can easily change into a hospital gown.
• Remove any jewelry.

It’s also a good idea to let your provider know if you:

• Have any conditions, such as an irregular heartbeat or blood clots in your legs or lungs
• Have had any surgeries to replace a heart valve
• Are pregnant or could be pregnant
• Have any allergies, including to latex, tape (adhesives), skin cleaners or medications, which include anesthesia

What happens during this procedure?

During thoracentesis, your provider will:

1. Use imaging tests such as an ultrasound or CT scan to see where the fluid is and determine how much is in your pleural space.
2. Connect you to machines to watch your heart rate and other vital signs.
3. Position you on the edge of a chair or bed with your arms resting on a table in front of you. You may also lie on your side on a bed.
4. Give you oxygen through a tube in your nose (nasal cannula) or with a mask.
5. Clean part of your back with a skin cleaner and cover the area with a drape.
6. Numb the area with a needle and local anesthesia. You may feel a pinch. Local anesthesia won’t make you fall asleep.
7. Make a small cut and insert a needle between your ribs to take out fluid. They may use a hand-held ultrasound device to help guide the needle.
8. Remove the needle and cover the area with a bandage.

After the procedure, they’ll send the fluid sample to a lab for analysis. They may also take more images of your lungs to check for any remaining fluid and make sure your lungs expand well after the procedure.

Who performs it?

The following healthcare providers may perform a thoracentesis:

• Pulmonologist
• Internist
• Intensive care doctors
• Thoracic or trauma surgeons

What are the potential benefits and risks?

Thoracentesis benefits include:

• It’s a safe, low-risk way for healthcare providers to figure out what’s causing pleural effusion.
• It relieves pressure on your lungs, which makes it easier to breathe.
• It’s an outpatient procedure, which means you can go home afterward.

Discomfort or pain after the anesthesia wears off is the most common side effect. You also may cough for up to an hour after the procedure. This is normal. It helps your lungs expand again.

Uncommon risks include:

• Bleeding
• Infection
• Collapsed lung
• Fluid buildup in your lungs
• Fluid comes back (recurrence), so you’ll need thoracentesis again

Is it painful?

Thoracentesis shouldn’t be painful. Local anesthesia numbs the area. Removing fluid may feel uncomfortable. In rare cases, it may be painful. If this happens, your healthcare provider will stop removing the fluid.

How many times can it be done?

Providers may do thoracentesis as often as every few days for certain conditions. But to reduce the risk of complications, they’ll only do it when they have to.

How long does it take to recover from thoracentesis?

The recovery time is short. You can usually take the bandage off after 24 hours. You may need to avoid strenuous activities for a few days. This includes:

• Riding a bicycle
• Jogging or running
• Lifting weights
• Swimming

It’s OK to shower. But you should avoid taking baths until the area heals.

Most people return to work or school a few days after the procedure. If your job requires a lot of physical activity, you may need to take more time off.

You should avoid flying for at least one week after the procedure.

When should I call my healthcare provider?

After the procedure, call your provider if you have any of the following symptoms:

• Chest pain or pain when you take a deep breath
• Coughing up blood
• Sudden shortness of breath or trouble breathing
• Signs of infection, including a fever, chills, swelling, bleeding or discoloration (red, brown, black, purple) around the affected area