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Introduction ⬇

Thoracoscopy is an examination of the thoracic cavity using an endoscope and allows visualization of the parietal and visceral pleura, pleural spaces, thoracic walls, mediastinum, and pericardium without the need for more extensive procedures. It is used most frequently to investigate pleural effusion and can be used to perform laser procedures; diagnose and stage lung disease; assess tumor growth, pleural effusion, emphysema, inflammatory processes, and conditions predisposing to pneumothorax; and perform biopsies of pleura, mediastinal lymph nodes, and lungs.

Video-assisted thoracoscopy is available for diagnosing intrathoracic diseases. This procedure can be used as a diagnostic device when other methods of diagnosis fail to present adequate and accurate findings. The discomfort and many of the risks associated with traditional diagnostic thoracotomy procedures are reduced with thoracoscopy.

Procedure ⬆ ⬇

  1. Thoracoscopy is considered an operative procedure. The patient’s state of health, the particular positioning needed, and the procedure itself determine the need for either local or general anesthesia. The incision is usually made at the midaxillary line and the sixth intercostal space.

  2. Many patients are discharged the following day, provided the lung has reexpanded properly and chest tubes have been removed.

  3. Follow guidelines in Chapter 1 for safe, effective, informed intratest care.

Clinical Implications ⬆ ⬇

Abnormal findings may include the following conditions:

  1. Carcinoma or metastasis of carcinoma

  2. Empyema (accumulation of pus in the lung pleura)

  3. Pleural effusion

  4. Conditions predisposing to pneumothorax or ulcers

  5. Inflammatory processes

  6. Bleeding sites

  7. Tuberculosis, coccidioidomycosis, or histoplasmosis

Interventions ⬆ ⬇

Pretest Patient Care

  1. Reinforce and explain the purpose, procedure, benefits, and risks of the examination and describe what the patient will experience. Record preprocedure signs and symptoms.

  2. Ensure that a surgical consent form is signed and witnessed and present in the patient’s medical record before the procedure begins (see Chapter 1).

  3. Complete and review required blood tests, urinalysis, recent chest x-ray film, and ECG (for certain individuals) before the procedure.

  4. Confirm that the patient has fasted for 8 hours before the procedure.

  5. Insert an IV line for the administration of intraoperative IV fluids and IV medication.

  6. Perform skin preparation and correct positioning in the operating room.

  7. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Obtain a postoperative chest x-ray film to check for abnormal air or fluid in the chest cavity.

  2. Connect chest tube and drainage system to negative suction, as ordered, if present.

  3. Monitor vital signs, amount and color of chest tube drainage, fluctuation of fluid in the chest tube, bubbling in the chest drainage system, and respiratory status, including pulse oximetry and arterial blood gases. Promptly report abnormalities to the healthcare provider.

  4. Administer pain medication as necessary and evaluate its effectiveness. Encourage relaxation exercises as a means to lessen the perception of pain. Monitor quality and rate of respirations. Be alert to the possibility of respiratory depression related to narcotic administration or intrathecal narcotic drugs.

  5. Encourage frequent coughing and deep breathing exercises. Assist the patient in splinting the incision during coughing and deep breathing to lessen discomfort. Promote leg exercises while in bed and assist with frequent ambulation if permitted.

  6. Use open-ended questions to provide the patient with an opportunity to express concerns.

  7. Document care accurately.

  8. Review test results; report and record findings. Modify the nursing care plan as needed.

  9. Follow guidelines in Chapter 1 for safe, effective, informed posttest care. Provide written discharge instructions.

Clinical Alert

  1. Do not clamp chest tubes unless specifically ordered to do so. Clamping chest tubes may cause tension pneumothorax. Sudden onset of sharp pain, dyspnea, uneven chest wall movement, tachycardia, anxiety, and cyanosis may indicate pneumothorax. Notify the healthcare provider immediately.

  2. Possible wound and pulmonary complications include the following:

    1. Acute respiratory distress, hypoxia

    2. Infection

    3. Hemorrhage (watch for unusually large outputs of blood in a relatively short period of time into the chest drainage system and notify healthcare provider immediately)

    4. Empyema (accumulation of pus in the lung pleura)

    5. Atelectasis

    6. Aspiration

  3. Nerve damage may occur during the procedure.

Reference Values ⬆

Normal