Pneumonia, congestive heart failure, and certain types of cancer are some of the conditions that may require Thoracentesis (“Thora’s”). Doctors use this procedure to remove excess fluid from around your lungs in order to diagnose problems that are not obvious at first glance. However, “Thora’s”, epidurals, and spinal blocks are putting the health of patients and medical staff at risk. So, how do we safeguard patients and medical staff? The article discusses “Thora’s”, patient positioning, and patient and medical staff safety.

What is a Thoracentesis?

Thoracentesis is a minimally invasive procedure that involves removing fluid from the chest wall and the space between the lining of the outside of the lungs (pleura). This space is called pleural space and it lies between these two areas and it usually contains only a thin layer of fluid. When there are at least four teaspoons of fluid in this pleural space, it is called pleural fusion. In the U.S., over 1.5 million people each year experience a pleural effusion. Many things can cause the fluid to build up. The fluid puts additional pressure on your lungs, making breathing difficult. To remove the excess fluid and figure out what is causing the buildup, doctors perform a “Thora’s”. Based on your underlying condition, your doctor may drain more or less fluid. Various diseases, like pneumonia, some forms of cancer, congestive heart failure, and many others, may result in excessive fluid accumulation (pleural effusion).

Common Reasons for Thoracentesis

Some uses for “Thora’s” includes:

• Assist in relieving lung pressure
• Treat symptoms like pain and shortness of breath
• Finding the cause of excessive fluid in the pleural space
• Ruling out an infection

Doctors can perform this procedure in offices, hospitals or imaging departments. Typically, imaging departments are favored because their ultrasound experts possess the equipment to correctly place the needle for drainage. Their sonographers generally handle all the setup and preparation required before procedures. So, when the patient is ready, the doctor can performs the procedure. The procedure also requires several clinical staff members. During “Thora’s”, the staff must manually position the patients on the table or bed. Manual handling of patients occurs throughout hospitals today. Similar to positioning patients for Thoracentesis, patients are also manually positioned for procedures like, spinal blocks and epidurals, not to mention all of the repositioning and turning of patients.  This has put strain on the health of RN’s, LVN’s, CNA’s, transport staff and anyone involved in direct patient care.  The risk of injury to nurses have increased over the years as patients continue to get heavier and our nursing population ages.

How the Procedure is Performed

In the past patients were positioned manually for Thoracentesis. Staff would have the patient sit comfortably on a bed or chair with their arms and heads leaning forward relaxed on a table. Usually, an LPN, nurse, or sonographer would help the patient in getting into the preferred position by maneuvering a bedside table and supporting the patient with a stool. It is possible to stack pillows on the table so the patient can lean forward in comfort. Unfortunately, many bedside tables have no locking mechanism, and they can tip over easily. Positioning the patient in a risky manner like using unstable tables with pillows is not beneficial to the medical staff or patients, and may result in a nursing injury. Even though studies show it takes on average 10 to 15 minutes to perform Thora’s. This old fashioned manual positioning simply puts patients and nursing staff at risk for injury. Several studies have shown that all levels of clinical and nursing staff are at risk for musculoskeletal disorders due to the high frequency of recurring manual patient handling tasks. However, in the past decade, the healthcare industry has made significant progress in reducing hospital and nursing injury risks by implementing evidence based Safe Patient Handling programs. With safe patient Handling and mobility devices, caregiver safety and quality of care can be enhanced.

Safe Patient Handling

Manual patient handling is a leading cause of nurse injuries. As a result, several states now require hospitals to follow Patient Handling laws. Each inpatient unit must be evaluated for high-risk tasks including lifting, pulling, pushing, or prolonged static holds, and ways to minimize the risks. Over the past two decades, patient care has advanced significantly, including many safe patient handling strategies and new technology like the Epidural Positioning Device (EPD). Also known as epidural chair, this device is effective at reducing injuries during spinal blocks, epidurals, and thoracentesis.

Epidural Positioning Device

The Epidural Positioning Device is a device used to position patients properly and comfortably by enabling the ideal spinal flexion of their thoracic, cervical, and lumbar areas while maintaining a stable and solid position. Supports for the chest, arms, and head can be manually adjusted to fit a variety of body types and sizes, and the back stays still during epidural insertion. The Epidural Chair is the best option for use in delivery suites, operating rooms, pain centers, and other areas where epidurals and spinal block are administered. The base of the EPD is known as the LDS base and features a height adjustable foot support for assisting with patient positioning and providing comfort. In addition, it includes a mount for the EPD, the upper section that is also height adjustable and includes the arm rests, chest support and face rest cushion. The upper section of the EPD can be attached via universal clamps to an operating table and adjusted in a similar manner.