can pulmonary edema be drained with thoracentesis?

[EarthwormRN]

A family member of my patient asked if his grandma could have the fluid drained through a tube. First i told him i wasn't sure if we could do that procedure here. Its a small rural hospital. Then i said since she was elderly and her progression of chf is severe the fluid may reaccumulate and the risks involved wouldn't be worth the procedure. This patient also had pneumonia but the chest xray didn't show a pleural effusion. My question is can you even drain the fluid from inside the lung rather than in the pleural space with a thoracentesis or does that only work for pleural effusions. After going home i kept wondering if i had misinformed the family. I did however explain that we were dieuresing her with lots of lasix and that was a safer alternative to pull the fluid off.

[akulahawkRN, ADN, RN, EMT-P]

If the fluid is within the lung tissue itself, putting a tube in the pleural space won't drain that off. It'll only drain fluid that's in the pleural space itself.

I used to work at a tiny, rural, critical-access micro-hospital and even there, the docs could/would perform thoracenteses and place chest tubes. That is rudimentary stuff.

To the rest of your post, though, I'll simply refer to akulahawk's succinct and concise statement.

[akulahawkRN, ADN, RN, EMT-P]

I'm normally more verobose...

As ♪♫ in my ♥ has stated, chest tube placement is rudimentary stuff. It's basically a higher-level monkey skill and you can actually find directions about how to do this on youtube. I've been trained to do needle decompression using either anterior or mid-axillary sites. The mid-axillary site is the same site that is used for chest tube placement. Could I place a chest tube? I state unequivocally that yes, I could. Would it be "pretty"??? Not likely, but it would be functional.

A good friend of mine is a Navy Corpsman who has had to place these under combat conditions. Yes, non-physician/non-nurse personnel can place these. Physicians (from my understanding) should have all gone through rotations where they have placed chest tubes. It's not so much that physicians at a given facility can't place them, but rather they either choose not to or that certain physicians are uncomfortable placing these and defer to others to do it. In the case presented, there wasn't an indication for chest tube placement so it wouldn't have been done.

Like any skill, you have to know when to do it as well as when not to do it. With pleural effusions & pneumothoraces, placement may be indicated. With pulmonary edema & pneumonia, you don't. It has to do with where the chest tube is located when placed, and that's within the pleural space and not within the lung tissue. In fact, puncturing the lung tissue shouldn't happen when placing these tubes.

[EarthwormRN]

Thank you for your answers. I feel better now. I'm always always learning new things. Even when i feel like I'm pretty comfortable with my knowledge i get challenged with a question i am totally unequipped to answer.