Medical Surgical Pleural Effusion & Thoracentesis #5

Question

The nurse is reviewing the past medical history on a client admitted for a thoracentesis. Which information in the client’s medical chart is most important as it relates to a possible contraindication to the procedure?

Answers

  1. Chest wall cellulitis.
    • Rationale:

      This answer is not correct because when there is an infection over the proposed site of the thoracentesis, a different entry site can be selected. Infections include cellulitis or herpes zoster.

  2. Client is mechanically ventilated.
    • Rationale:

      This answer is not correct because a client who is mechanically ventilated can go under thoracentesis as long as caution is exerted. Usually an ultrasound-guided thoracentesis is recommended in this situation.

  3. Client has an empyema.
    • Rationale:

      This answer is not correct because an empyema is clinically indicated for thoracentesis. An empyema is pus in the pleural space as a result of an infection.

  4. Thrombocytopenia.
    • Rationale:

      This answer is correct because a client with thrombocytopenia is at risk for bleeding out. Coagulopathy is a relative contraindication in thoracentesis. Thoracentesis should be deferred in the client who is hemodynamically compromised until stabilized. Blood thinners should be stopped before the procedure.

Overview

A thoracentesis is a procedure where a surgeon gently inserts a large bore needle through the intercostal space between the lungs to drain fluid. One of the biggest complications of a thoracentesis is bleeding out.

Explanation

Learning Outcomes

A thoracentesis is a procedure where a surgeon gently inserts a large bore needle through the intercostal space between the lungs to drain fluid. One of the biggest complications of a thoracentesis is bleeding out. Coagulopathy is a relative contraindication in thoracentesis. Thoracentesis should be deferred in the client who is hemodynamically compromised until stabilized. Blood thinners should be stopped before the procedure. In the mechanically ventilated client, ultrasound-guided thoracentesis is usually recommended. A client with a potential skin infection, a different entry site will be selected.

Test Taking Tip

When you come to a question where you do not know the answer, just make an educated guess from your basic nursing knowledge.

Video Rationale