Preparation
Before the procedure, the patient is first given a detailed explanation of the procedure and possible complications. If the procedure is planned, the patient should be informed <24h before the procedure. After the doctor has explained the procedure to the patient and before the procedure, a written consent form must be signed.
Laboratory values are then taken before the puncture, with the help of which the doctor can get an overview of the blood coagulation and assess whether the intervention is possible. With the aid of an ultrasound device, the effusion is displayed again before the puncture, compared with any previous findings and evaluated. If the area to be punctured is very hairy, it is shaved with disposable razors before the procedure.
ImplementationTechnology
First, the patient is placed in the optimal position for the procedure. Mobile patients sit with their back to the examiner with a cat’s hump. Bedridden patients are positioned by the staff either in a supine or lateral position so that the puncture site is easily visible and puncturable for the examiner.
If the patient is well positioned, the effusion is re-examined between the ribs and determined with the help of ultrasound and with the help of external landmarks such as the puncture site and the puncture route. This is usually located between the 4th -6th intercostal space at the side, should be as far away from the lungs as possible and aim at the site of the greatest extent of the effusion. If the puncture site is selected, it is marked.
The area is then disinfected and sterilely covered so that only the disinfected area to be punctured is exposed. Then a local anesthetic is injected to anaesthetize the area. This small injection can be felt as unpleasant.
Under constant anaesthesia of the deeper layers, the examiner punctures between the ribs in the direction of the effusion accumulation. The puncture is then made along the upper edge of the rib, since nerves and blood vessels are located at the lower edge.If the so-called test puncture was successful, a special needle is inserted in the same puncture channel, through which the effusion can then be relieved. If the effusion is completely aspirated, the patient may cough slightly.
However, no more than 1.5l of effusion should be aspirated at once, as this increases the complication rate after the procedure. The pleural puncture is usually not painful. The only thing that may be perceived as possibly unpleasant by the patient is the injection of the local anesthetic.
However, the pain that occurs here is no stronger than an insect bite and subsides immediately. The rest of the procedure is not painful for the patient. After the puncture is completed, the patient feels much better, as the lungs are relieved and the breathing work is much easier. Pain after the procedure due to the puncture is extremely rare.
