Changes

==Complications==

==Complications==

==Peritoneal Fluid Analysis==

==Peritoneal Fluid Analysis==

Thoracocentesis is a procedure which has both diagnostic and therapeutic value.  

Thoracocentesis is a procedure which has both diagnostic and therapeutic value.  

When the clinical history, presenting signs and thoracic auscultation suggest a pleural effusion, thoracocentesis can both confirm its presence and provide a specimen for examination. It can be particularly useful in the emergency patient who is too unstable to undergo radiography or similar diagnostic tests as drainage of pleural fluid will both confirm its presence and improve clinical signs.

When the clinical history, presenting signs and thoracic auscultation suggest a pleural effusion, thoracocentesis can both confirm its presence and provide a specimen for examination. Ideally radiography (minimum of two views - lateral and dorsoventral) or ultrasound should be performed to confirm diagnosis prior to thoracocentesis. However it can be particularly useful in the emergency patient who is too unstable to undergo radiography or similar diagnostic tests as drainage of pleural fluid will both confirm its presence and improve clinical signs.  

==Equipment==

==Equipment==

* Sterile gloves

* Sterile gloves

* Sterile needle (1 inch with the smallest possible gauge) with extension set or butterfly needle with incorporated extension set

* Sterile needle (1 inch with the smallest possible gauge) with extension set or butterfly needle with incorporated extension set

* Sterile syringe

* Large volume sterile syringe

* 3-way tap - if large volumes of fluid are anticipated, as this allows for multiple syringe-fulls of fluid to be removed safely

* 3-way tap - if large volumes of fluid are anticipated, as this allows for multiple syringe-fulls of fluid to be removed safely under a closed system

* EDTA tube, plain tube and sterile vial for culture

* EDTA tube for cytology and plain tube for biochemistry and culture

Sedation is not generally required, especially in the dyspnoeic patient (however it can be used if necessary to prevent further stress to an excitable animal).

Sedation is not generally required, especially in the dyspnoeic patient (however it can be used if necessary to prevent further stress to an excitable animal). The patient should be handled gently and potentially placed in an oxygen cage prior to the procedure as they often have a poor oxygen reserve.

==Procedure==

==Procedure==

The site for thoracocentesis is between the 7th and 8th intercostal space. If fluid is suspected in the pleural space then the needle should be inserted 2/3rds of the way down the chest. If pneumothorax is suspected then the needle should be inserted more dorsally, approximately 1/3rd down the chest. Local anaesthetic is not normally needed.

The site for thoracocentesis is between the 7th and 8th intercostal space. If fluid is suspected in the pleural space then the needle should be inserted 2/3rds of the way down the chest. If pneumothorax is suspected then the needle should be inserted more dorsally, approximately 1/3rd down the chest. Local anaesthetic can be used if necessary.

* Clip and scrub a generous area around the 7-8th rib space on both sides of the chest.  

* Clip and scrub a generous area around the 7-8th rib space on both sides of the chest.  

* A small amount of negative pressure should be applied as the needle passes through the thoracic wall.

* A small amount of negative pressure should be applied as the needle passes through the thoracic wall.

* The needle should be angled downward, parallel to the body wall. The fluid or air should then be aspirated.  

* The needle should be angled downward, parallel to the body wall. The fluid or air should then be aspirated. The needle may need redirecting to access pockets of fluid.

==Complications==

==Complications==

==Peritoneal Fluid Analysis==

==Peritoneal Fluid Analysis==

Analysis of the pleural fluid may in turn help you to determine the underlying disease process and develop a therapeutic plan.  

Analysis of the pleural fluid may in turn help you to determine the underlying disease process and develop a therapeutic plan.

 

The types of fluid that may cause pleural space disease are: exudate, modified transudate, transudate and chyle. These can be identified by the protein and cellular content of the sample.  

=References=

=References=

RVC staff (2009) '''Respiratory System''' RVC Intergrated BVetMed Course, ''Royal Veterinary College''

RVC staff (2009) '''Respiratory System''' RVC Intergrated BVetMed Course, ''Royal Veterinary College''

add electives reference and in practise reference.

Rutgers, C H (1989) '''Thoracocentisis in the dog and cat''' ''In Practice 1989 11: 14-1''

 

 

[[Category:To Do - Siobhan Brade]]

[[Category:To Do - Siobhan Brade]]