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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. 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.  

When the clinical history, presenting signs, thoracic auscultation and percussion of the animal 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 pleural space disease prior to thoracocentesis. However it can be particularly useful in the emergency patient (the dyspnoeic cat in particular) who is too unstable to undergo radiography or similar diagnostic tests as drainage of pleural fluid will both provide a preliminary diagnosis and improve clinical signs.

==Equipment==

==Equipment==

* Ultrasonography if available

* Ultrasonography if available

* Sterile gloves

* Sterile gloves

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

* Butterfly needle with incorporated extension set or sterile needle (1 inch with the smallest possible gauge) with extension set

* Large volume sterile syringe

* 20ml 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 under a closed system

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

* EDTA tube for cytology and plain tube for biochemistry and 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). 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.

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 the procedure performed in a quiet environment. It may be necessary to place the animal in an oxygen cage prior to the procedure as they often have a poor oxygen reserve.

==Procedure==

==Procedure==

* 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 may need redirecting to access pockets of fluid.

* 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.

 

Up to 100mls of fluid per side can be expected in the cat. Removal of fluid should see an improvement in clinical signs.

==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 following can be analysed: cytology, total cell count, differential cell count, total protein, bacterial culture ans sensitivity, gram stain and triglyceride and cholesterol levels (if chylothorax is suspected).  

The following can be analysed: cytology, total cell count, differential cell count, total protein, bacterial culture ans sensitivity, gram stain and triglyceride and cholesterol levels (if [[Chylothorax|chylothorax]] is suspected).  

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.  

The types of fluid that may cause pleural space disease are:  

 

 

 

 

 

These can be identified by the protein and cellular content of the sample.

 

The fluid fluid can give an indication of prognosis; in the cat prognosis is generally poor for all diagnosis except [[Pyothorax|pyothorax]] (an exudate with degenerate neutrophils and intracellular bacteria). Therefore it is often useful to perform in-house cytology to give a preliminary diagnosis, which allows the owners to make an informed decision before proceeding with further treatment. Differential diagnosis in the cat include [[Heart Failure|congestive heart failure]], [[Feline Infectious Peritonitis|FIP]], [[Pyothorax|pyothorax]], [[Neoplasia - Pathology|neoplasia]], [[Haemothorax|haemothorax]] and [[Chylothorax|chylothorax]].

=References=

=References=

Mair, TS & Divers, TJ (1997) '''Self-Assessment Colour Review Equine Internal Medicine''' ''Manson Publishing Ltd''

Mair, TS & Divers, TJ (1997) '''Self-Assessment Colour Review Equine Internal Medicine''' ''Manson Publishing Ltd''

[[Category:To Do - Siobhan Brade]]

[[Category:To Do - Siobhan Brade]]