Thoracentesis

ʻO Thoracentesis kahi hana e hemo ai ka wai mai ke ākea ma waena o ka uhi o waho o nā akemāmā (pleura) a me ka paia o ka umauma.

Hana ʻia ka hōʻoia ma ke ala aʻe:

• Noho ʻoe ma luna o kahi moe a ma ke kaʻe o kahi noho a moe paha. Kau kou poʻo a me kou mau lima i ka papa.
• Hoʻomaʻemaʻe ʻia ka ʻili a puni ka pae hana. Hoʻokomo ʻia kahi lāʻau numbing kūloko (anesthetic) i loko o ka ʻili.
• Hoʻokomo ʻia kahi nila i loko o ka ʻili a me nā mākala o ka paia o ka umauma i kahi ākea e pili ana i nā akemāmā, i kapa ʻia ʻo ka pleural space. Hiki i ka mea mālama ola ke hoʻohana i ka ultrasound e ʻike i kahi i ʻoi loa e hoʻokomo i ka nila.
• Noi paha ʻoe e hoʻopaʻa i kou hanu a i ʻole hanu i ka wā o ke kaʻina hana.
• ʻAʻole pono ʻoe e puʻe, hanu hohonu, a neʻe i ka wā o ka hoʻāʻo e pale i ka hōʻeha i ka hū.
• Kuhi ʻia ka wai me ke kui.
• Wehe ʻia ka nila a hoʻopaʻa ʻia ka wahi.
• Hoʻouna ʻia ka wai i kahi keʻena hoʻokolohua no ka hoʻāʻo ʻana (pleural fluid analysis).

ʻAʻole pono kahi hoʻomākaukau kūikawā ma mua o ka hoʻāʻo. E hana ʻia kahi x-ray umauma a i ʻole ultrasound ma mua a ma hope hoʻi o ka hoʻāʻo.

E ʻike ʻoe i kahi nahenahe ke kuhi ʻia ka anesthetic kūloko. ʻIke paha ʻoe i ka ʻeha a i ʻole kaomi ke hoʻokomo ʻia ka nila i loko o ka pleural space.

E haʻi i kāu mea hāʻawi inā ʻike ʻoe i ka pōkole o ka hanu a i ʻole ʻeha ka umauma, i ka wā a ma hope paha o ke kaʻina hana.

ʻO ka maʻamau, heʻuʻuku loa ka wai i ka pleural space. ʻO ke kūkulu ʻana o ka wai i nui loa ma waena o nā papa o ka pleura i kapa ʻia he pleural effusion.

Hana ʻia ka hoʻāʻo e hoʻoholo ai i ke kumu o ka wai keu, a i ʻole e hōʻoluʻolu i nā ʻōuli mai ke kūkulu ʻana o ka wai.

ʻO ka maʻamau he mau liʻiliʻi wale nō ka wai o ka pleura.

ʻO ka hōʻoia ʻana i ka wai e kōkua i kāu mea hoʻolako e hoʻoholo i ke kumu o ka pleural effusion. ʻO nā kumu i hiki ke hoʻopili ʻia:

• Kanesa
• Hoka kōpaʻa
• Hewa puʻuwai
• Nā pae protein haʻahaʻa
• ʻO ka maʻi kīwī
• Trauma a post-ʻoki
• ʻO ka hopena pleural-pili plebible
• ʻO ka maʻi maʻi collagen (ka papa o nā maʻi kahi e hoʻouka ai ke kino pale o ke kino i kāna mau iho ponoʻī)
• Nā hopena lāʻau
• ʻOhi o ke koko i ka pleura space (hemothorax)
• Kanesa maʻi ʻaʻai
• ʻO ka pehu a me ka mumū o ka pancreas (pancreatitis)
• Pulumonia
• Ka poloka o ke aʻa i loko o nā akemāmā (pulmonary embolism)
• ʻO ka pākana thyroid ikaika ʻole

Inā kuhi kāu mea hāʻawi iā ʻoe he maʻi, hiki ke hana ʻia kahi moʻomeheu o ka wai e hoʻāʻo no nā bacteria.

Hiki i nā pilikia ke hoʻopili i kekahi o kēia mau mea:

• Kahena
• Maʻi kīnā
• ʻO ka hāhā naha (pneumothorax)
• Hoʻopilikia hanu

Hana ʻia kahi x-ray umauma a ultrasound paha ma hope o ke kaʻina hana e ʻike i nā pilikia kūpono.

Pleural fluid aspiration; Piula Pleural

ʻO Blok BK. Thoracentesis. I: Roberts JR, Custalow CB, Thomsen TW, eds. ʻO Roberts a me Hedges 'Nā Kauka Lapaʻau i ka Medicine Emergency a me ka Care Acute. ʻEpekema 7 Piladelapia, PA: Elsevier; 2019: chap 9.

Chernecky CC, Berger BJ. Thoracentesis - hōʻike maʻi. I: Chernecky CC, Berger BJ, hua. Nā Hoʻokolohua Laboratory a me nā kaʻina hana Diagnostic. ʻElua huaʻōlelo St Louis, MO: Elsevier Saunders; 2013: 1068-1070.