Voiceover: So, when an individual has a pleural effusion,
one of the more common procedures that'll we do
to clear that effusion is to do a thoracentesis,
and a thoracentesis essentially is,
we will go in with a needle, right, and we're going to
inject the needle into that pleural space,
and we're going to withdraw or aspirate all of that fluid.
So, the image that you are looking at,
I know it looks a little busy or crazy,
but let me explain what we're looking at here.
So, here's a lung, okay?
So, this is like we're doing a cross section view
of a space, so we can see this pleural effusion.
So, here's just part of the lung,
and we're looking at the base.
This is a lung base.
Here is the actual effusion, right?
So, that's the fluid.
So, this means that this is our pleural space here,
and, of course, that this darker pink color,
that would be our visceral membrane or visceral pleura,
and then this yellow color here, this in-between wall,
that would be our parietal.
I'm going to write that there.
And then here, these little white dots,
this is our ribs, right?
So, we're looking at our ribs
like cut down through the cross section.
In between our ribs, we can see that we have our
intercostal muscles, and then, on the outside of our ribs,
so, this would essentially be our subcutaneous, right?
So, I'm going to write SQ.
That's our subcutaneous tissue.
That's our fatty tissue.
And then, outside of that, well, this is just our skin.
So, entry would be this,
entry would be going in with the needle.
Here's my needle, going through the skin,
through the fat, through the muscle in between the ribs,
into this pleural space, to get that fluid
and drain it back out.
So, that's what we're looking at, just that same way.
So, I'm going to take away my needle, so we can talk
a little bit more about what we're looking at.
So, what's important about doing a thoracentesis
is making sure that we're using the right technique
so we don't damage the tissues,
and we don't cause any harm to the patients.
Now, for this particular image that we're looking at,
we want to make sure that
we are careful with the VAN bundle,
and this stands for our vein, artery, and nerve bundle.
Now, if you look here, and I'll zoom in,
you look here, right underneath,
so this inferior portion of each rib,
we have this bundle, and I have them colored
red, blue, and yellow.
Our red is going to represent our artery,
the blue is going to represent our vein,
and the yellow will represent our nerve.
So, we have a bundle of all three of these things
right underneath each rib.
What does this mean?
Well, when we're doing a thoracentesis,
again, when we're going in with our needle
into this space, we need to be careful, boom,
we need to be careful that we don't hit that VAN,
and the reason for that is our vein, artery, nerve bundle,
it really is responsible for a lot of things.
So, imagine if we nicked an artery.
We could be looking at severe bleeding,
hemorrhaging, right?
Right into this space, which could lead to hypotension,
so really dangerously low blood pressure,
because we're losing the fluid.
We could go into shock.
If by accident we injured that nerve,
well, then we could lose respiratory function,
because that nerve, and I'm abbreviating respiratory,
that nerve actually controls some of our muscle movement.
So, just think about all the terrible things
that could happen if we accidentally hit the VAN.
We would really be putting this patient
at a large potential of risk and for some serious damage.
So, when we are doing a thoracentesis,
there is a proper way that we should be doing it.
First of all, always ultrasound-guided.
So, I'll put US, ultrasound, always ultrasound-guided,
because we want to make sure that we're visualizing
where we're going, so we don't cause any damage.
Normally, when we're doing a thoracentesis,
we go above the ninth rib.
So, let's just say that this guy here, this is my ninth rib.
So, I'm going to go right above the ninth rib
with my needle, right above it.
My needle curved a little bit,
but we'll say we're going straight,
right into the pleural space,
and I'm going to withdraw the fluid.
The reason why I'm going right above the ninth rib,
one is because by going above the rib,
I'm avoiding that nerve, artery...vein, artery, nerve
bundle, excuse me, and the ninth is kind of like
our landmark, and the reason is,
is that it's low enough at the base of the lungs,
because remember gravity, this person is sitting up
during the thoracentesis, so that means
that all the fluid is going to go to the bottom,
so it's low enough that we can collect fluid
at the base of the lung but not too low that we hit
the diaphragm by accident.
So, this is going to be my ninth rib.
Now, when we do that thoracentesis,
we know that what we're doing,
we go in with the needle, and essentially on the other side,
what's happening is that we're having the fluid
drain out through the needle.
Actually, let me change the color.
So, we're going to have the fluid drain out
through the needle, and that's going to go into
some kind of collection container.
So, that can be like a vial that we have,
and that's a pretty bad vial, or it can go into
a collection bag, and we want to make sure that we
collect this fluid, that way we can test it,
and what we'll do is, we'll use Light's criteria
to test it to tell if it's a transudate fluid
or it's an exudate fluid, and this way,
we know what caused it.
So, it's really important that we're careful not to hit
that VAN bundle, or else we can cause some damage.
So, just by remembering the hallmarks,
so here's our ninth rib, that's really a good spot
that we want to be going into,
and ultrasound-guided, of course, so we can make sure
that we don't cause any harm to the patient.