Special Procedures

Diagnostic or therapeutic procedure which a needle is inserted into the chest to remove air/fluid from the pleural space. 

Pleural effusion 

Patient sitting up and leaning forward. 

7th or 8th intercostal space at the site of maximal dullness.

100 to 300 ml of pleural fluid with 50 mL syringe. 

• Clear and has light straw color
• Congestive heart failure

Opaque appearance and called exudate fluid 

yellow or milky exduate fluid 

apnea due to loss of ventilation effort

blockage of upper airway 

• Daytime sleepiness and insomnia at night. 
• Muscle twitching 
• History of snoring and obesity 

observation in sleep lab (polysmnography) 

• Chest motion detectors to measure respiratory effort
• Flow detectors to measure nasal flow
• Oximetry measure oxygen desaturation

central problem 

• Weight loss
• Surgery
• Respiratory stimulants
• Tracheostomy
• Nasal/mask CPAP and or NIPPV therapy 

20

CPAP first 

• Patient cant tolerate high pressures on CPAP
• Continued obstructive respiratory events when patient reaches CPAP presure 15 cmH₂O

• Increases patients tolerance of PAP thearpy
• To treat central sleep apnea

• Pneumothorax
• Hemothorax

• Air enters pleural space with little or no fluid.
• If air cant escape lung mediastinum is affected pushing it away from affected side=tension pnumothorax.

• Fluid enters pleural cavity with no air. 
• Insert large bore needle to relieve pressure. Insert chest tube 

Placed in anterior chest (second intercostal space in midclavicular line)

Placed in 4th or 5th intercostal space in midaxillary line. 

• Tube clamped 24hrs before removing tube.
• Observed for respiratory distress 
• X-ray taken
• Just before removing tubes patient takes deep breath, exhales & performs valsalva maneuver.