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=Equine Thoracocentesis=
==Introduction==
==Introduction==
Thoracocentesis is a procedure which has both diagnostic and therapeutic value.
Thoracocentesis is a procedure which has both diagnostic and therapeutic value.
Pleural fluid from healthy horses may contain up to 10,000 nucleated cells/l and 35g/l total protein.
Pleural fluid from healthy horses may contain up to 10,000 nucleated cells/l and 35g/l total protein.
Most horses have less than 5,000 nucleated cells/l and less than 25g/l total protein.
Most horses have less than 5,000 nucleated cells/l and less than 25g/l total protein.
=Small Animal Thoracocentesis=
==Introduction==
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.
==Equipment==
* Clippers and materials to perform a surgical scrub
* Ultrasonography if available
* Sterile gloves
* Sterile needle (1 inch with the smallest possible gauge) with extension set or butterfly needle with incorporated extension set
* 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
* EDTA tube, plain tube and sterile vial for 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).
==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.
* Clip and scrub a generous area around the 7-8th rib space on both sides of the chest.
* Advance the needle slowly at a 45 degree angle in the middle of the 7th or 8th intercostal space into the pleural space.
* 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.
==Complications==
Pneumothorax
==Peritoneal Fluid Analysis==
Analysis of the pleural fluid may in turn help you to determine the underlying disease process and develop a therapeutic plan.
=References=
=References=