Aftercare
When the puncture is completed, the needle is removed and pressed onto the puncture site with a swab. Then it is well connected and fixed with a stable adhesive bandage. The ultrasound device is then used to check again whether there is still residual effusion in the pleural gap.
Any findings are documented. By listening to the sounds in the lungs, a test is performed to determine whether the lung is developing properly again. By listening to the lung sounds, possible complications such as a pneumothorax can be ruled out.
If complications occur during the procedure, an X-ray of the lung should be taken immediately. If the operation was free of complications, an X-ray in the exhalation position should be taken within 12-24h. After the puncture, the patient’s vital parameters (blood pressure, heart rate, oxygen saturation of the patient) and any shortness of breath are monitored.
Risks
In rare cases, complications can arise during a pleural puncture. This may involve bleeding in the area of the puncture site. This can occur, for example, if the patient has a previously unrecognized coagulation disorder.
Another complication can be an infection of the puncture site. In addition, the puncture may result in injury to neighboring organs or tissue structures, e.g. lungs, diaphragm, liver or spleen. In rare cases, pulmonary edema and possibly renewed accumulation of effusions may also occur.
This may be the case if the effusion is aspirated too quickly, resulting in excessive negative pressure in the pleural gap. A pneumothorax is when air enters the pleural gap and the negative pressure normally prevailing there is lost, causing the corresponding lung to collapse. This can occur as a result of traumatic injuries from the outside, e.g. a knife wound, or as a complication of a pleural puncture.
A life-threatening situation can be caused by a tension pneumothorax, in which more and more air gets into the pleural gap through the so-called valve mechanism and cannot escape again. This can lead to a displacement of the heart, the large blood vessels and the lung to the opposite side, which can lead to respiratory and circulatory insufficiency. A tension pneumothorax is a life-threatening condition and must be treated immediately as an emergency.
Pneumothoraces can also occur spontaneously. This is mainly observed in young men. Therapeutically, an attempt is made to remove the air with the help of a thoracic drainage, to restore the negative pressure required in the pleural gap and in this way to cause the lung to re-deploy and to attach itself to the thoracic wall from the inside.
