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Skill checklist for 4 semester

Govt College of nursing bannu

Batch 2020-2023
Prepared By:- Saira bibi
Subject: - Thoracentesis

1. Check doctor order for lumber puncture.
2. Perform hand hygiene, provide patient privacy and introduce yourself.

 Dressing set
 Abraham’s needle
 Connecting tubing
 Syringe
 Needles (18 and 23 gauge)
 Sterile Glove
 Mask
 Povidone/Alcohol
 Local anaesthetic
 Formalin bottle
 Urine bottle x2
 C+S bottle
 3-way stopcock

1. Explain the purpose, risk and steps of the

procedure and obtain consent from the patient
or appropriate legal design.
2. Do Diagnostic Tests such as
 Chest X-ray
 Ultrasound
3. Check platelet count and presence of
4. Place patient upright position.
5. Explain that he/she will receive a local
6. Clean patient skin with antiseptic.
7. Observe patient respiration rate and breathing
8. Assess patient vital sign such as B/P, pulse.
9. Observe patient level of consciousness and give
emotional support.
10. Monitor saturation.

11. Drain max 1.5L in one sitting.

12. Position the patient at 30 degree.

13. Sedate lightly with midazolam.

14. Wear sterile gown and gloves.

15. Clean the skin from mid-chest to mid-

16. Sterile drapes on the patient.

17. Identify the anatomic landmark

 Xiphoid process
 5th & 6th ribs
18. Select a site for needle insertion.

19. Most commonly used sites

 Left sternocostal margin
 Subxiphoid approach
20. Infiltrate the skin and subcutaneous tissues
with local anesthetic
 Starting 1-1.5 cm below the xiphoid and
left of midline.
 Staying close to the inferior border of
the rib cartilages.
21. Insert the needle
 Between xiphoid and left costal margin.
 Angled at 30 deg.
22. Advance slowly,
 Aspirating & injecting lidocaine.
 Aiming for the left shoulder.
23. Aspirate during insertion.

24. Stop advancing the needle once fluid is

25. Continue aspirating.

26. Reassess for improvement.

27. Repeated if necessary.

28. Document the procedure and related

assessment finding. Repeat any concern
according to agency policy.

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