„ Thoracocentesis is the name given to a

clinical technique whereby fluid or air is

removed from the thoracic cavity.

Thoracocentesis „ Indication
Removal of air/fluid from the thoracic cavity
Analysis of fluid
Chollada Tasu Improved radiographs

Technique
„ Insertion of the needle
Position
„ the middle of the correct
intercostal space
„ avoid the blood vessels and
nerves that run down the
caudal edge of each rib
direction
„ a 45' angle towards the parietal
pleura
„ preventing the lung
parenchyma from obscuring
the needle lumen when
aspiration is being performed.
posture
plueral effusion „ standing or in lateral or sternal
recumbency.

„ Firstly, the needle should be inserted through

Aseptic conditions
„ wear sterile gloves
the superficial fascia, integument and muscle.
„ avoids the iatrogenic introduction of an infection into the „ Secondly, the needle should be moved
pleural space.
dorsally or ventrally about 1 cm and then
withdraw needle
inserted through the rest of the muscle and
„ coughs, struggles or shows signs of discomfort during the
technique
the parietal pleura.
hold the needle/syringe parallel to the body wall with „ reducing the risk of a pneumothorax.
the tip pointing ventrally
„ reduces the risk of lung laceration.
Local anaesthetic
„ useful if remove large volumes of fluid

1
 TO REMOVE FLUID:
„
Position
Equipment required for
„
„
ventral third of the thorax
the 6th-8th intercostal spaces thoracocentesis
insert the needle cranial to the costodiaphragmatic line,
caudal to the basal border of the lung and within the „ Sterile Needle
ventral third of the thorax Cat, 18-23 gauge
Dog, 18-21 gauge
„ TO REMOVE AIR:
the 6th-8th intercostal spaces but at the highest point of the „ Both of these are 1" long.
thorax. „ Butterfly
Standing or Sternally Recumbent- Dorsal third of the
thorax. „ a flexible polythene catheter
Laterally Recumbent- Mid thorax. with removable needle
„ Three-Way
„ Syringe- Usually 10-30ml so
that large volumes of fluid/air
can be collected.

Analysis of fluid
Fluid
„
analysis
Appearance
Effusion
type
Appearance Protein
content
Total
nucleated
Cell types
typically
Useful
biochemical
„ EDTA tube (g/l) cell count present parameters
(x109/l)
total protein concentration Transudate Clear, may 5-10 0.5-1.0 Mesothelial
specific gravity be yellow or cells, some
total nucleated and red cell counts, and cytology. colorless WBC
Modified Clear or 15-30 1-5 Mesothelial
„ plain tube
transudate slightly cells,
bacteriological examination turbid; Macrophages
other biochemical tests eg triglycerides and cholesterol usually , PMN, some
red/orange or RBC
„ Smears should be prepared immediately after collection Chylus yellow
Milky white or 30-85 Variable: 2- Small Triglyceride,
using a drop of thoroughly mixed fluid or the sediment pink 60 lymphocytes cholesterol
from a centrifuged sample. Haemorrha Dark red, 40-80 RBC,
centrifuge at slow speed i.e. 1000-1500 RPM for 5 gic sanguinous variable
mins. WBC content

Septic Variable: cloudy, >25 50+ PMN (usually

exudate turbid, may be degenerate)
granular; often ±organisms,
coloured macrophages,
mesothelial cells

Non-septic Clear or turbid; >30 25+ Variable,

exudate may be coloured mesothelial cells,
yellow/ orange macrophages,
PMN,
Neoplastic Variable: clear 30-80 Varia lymphocytes
Mesothelial cells,
or red/orange; ble macrophages,
maybe slightly PMN, maybe
turbid; maybe neoplastic cells Peritoneal fluid, septic Pleural fluid, septic pleuritis
sanguious peritonitis

2
 „ Haemorrhagic exudates
Type of effusion Thoracic trauma
„ Pure transudate Intrathoracic tumour
Low protein level in the plasma (hypoproteinemia)
Congestive cardiac failure „ Exudates
„ Modified transudate Septic or non-septic
High venous and capillary hydrostatic presure
„ Congestive heart failure Septic
„ Obstruction of vein and/or lymphatics –intrathoracic mass „ Positive culture
„ Chylous effusions „ Foreign body
Thorax –rupture of the thoracic duct „ Penetratign wound of the thorax, oesophagus or airway
Intrathoracic lymphagiectasia
„ Obstruction or trauma Non-septic
Cat „ Negative culture
„ chylothorax –cardiac failure
„ Immune-mediated process
„ Pseudochylous effusion –intrathoracic neoplasia
Triglyceride > plasma „ Parasitic or neoplastic process
cholesterol < plasma except in pseudochylous „ Cat –feline infectious peritonitis

•Sedation and local anesthetic infiltration

Placement of a Thoracic Drain •clipped of hair and scrubbed with
antiseptic solutions
•lateral recumbancy

A flexible, rubber feeding tube with additional •the 10th intercostal space, tunnel
fenestrations subcutaneously, 2 to 3 spaces, and
penetrate the chest wall at the 7th or 8th
intercostal space.

an argyle styleted thoracic drain

•estimate the length of tubing that will be •attach a syringe to the catheter and remove fluid and/or air
inserted into the pleural space •clamped closed and sutured in place
•ideal position of the tip of the tube is to lie along •a purse string suture is placed in the skin incision around
the sternum, anterior to the heart
the catheter
•the suture tied around the subcutaneous segment of the
tube.

•Pass the hemostat in an anterior direction in the subcutaneous space

for a distance of 2 or 3 rib spaces
•drive the hemostat through the chest wall at the 7th or 8th intercostal
space

3
 „ Pericardiocentesis is the insertion of a
needle or catheter into the pericardial sac.

to evaluate and/or drain pericardial effusion

Pericardiocentesis to relieve cardiac tamponade

Removing the fluid relieves pressure on the

heart and allows it to fill and pump blood more
effectively.

„ Diagnosis of pericardial effusion

Thoracic radiography
„ Cardiac silhouette –globe-shape
Electrocardiography Electrical alternans in a lead II ECG strip.
„ Electical alternans
Echocardiography
„ 15 ml of intrapericardial fluid
„ Anechoic between pericardial and epicardial

A right parasternal transverse heart base view

demonstrating pericardial effusion and a mass
on the right atrial wall.

„ Equipment
Procedure
Scalpel blade –stab skin
incision Preparation of dog
20-50 ml syringes „ Check CBC, clotting time
3-way stopcock „ Mild sedation
Needle or pericardiocentesis „ Sternal or left lateral recumbency attach the
catheter ECG monitor
„ Cat 19-21 gauge butterfly Epicardial –ventricular arrhythmia
catheter
„ Large dog 19 gauge
„ A large area of right hemithorax (sternum to
midthorax, 3rd -8th rib)
ECG monitor
„ Shave and surgically preparation
2% lidocaine
Analgesic –morphine, „ Local anesthesia at the site of puncture, deep to
acepromacine the pleural membrane
2% lidocaine

4
Procedure for pericardiocentesis Cause of effusion
„ Stap incision
Puncture site „ Transudate/modified transudate
„ Base on the location of the heart on Congenital pericardio-peritoneal hernia
the thoracic radiography Right-sided congestive heart failure (usually with ascites)
„ 4th -6th space at costochondral Hypoalbuminemia
junction
Idiopathic
„ Insert needle
„ Haemorrhage
„ Redirect the needle to Left atrial rupture
pericardium Intra-pericardial neoplasia
„ Withdraw the pericardial effusion Trauma
„ Remove needle and suturing the Coagulopathy
skin Idiopathic benign pericardial haemorrhage
„ Exudate
„ Ultrasound guidance
infection
Not necessary except small volume
of fluid

„ Abdominocentesis is a procedure in which fluid

is removed from the abdomen using a needle.

indication
Abdominocentes „ Dyspnea dog and cat due to abdominal
distention
is „ Fluid analysis

Equipment
„ an 18- to 20-gauge 1½-inch needle
„ a 12- to 20-ml syringe
„ สายน้ําเกลือ

Procedure
•Check CBC, clotting time „ Complication
•Sternal or left lateral „ puncturing the bowel
recumbency Peritonitis
•Shave and surgically
preparation „ hemorrhage from a solid abdominal organ
•site for abdominal paracentesis punctured
is 1 cm anterior to the umbilicus
and approximately 1 cm to the
right of the midline
•local anesthetic
•maintain the needle as parallel
to the body wall