In intrapleural administration, the practitioner inserts a needle into the fourth to eighth intercostal space, 3" to 4" (7.5 to 10 cm) from the posterior midline, and then advances the needle medially over the superior edge of the patient’s rib through the intercostal muscles until it tangentially penetrates the parietal pleura. The practitioner advances the catheter into the pleural space through the needle, and then removes the needle. The nurse should assist the practitioner with insertion, as necessary. After inserting the catheter, the practitioner coils it to prevent kinking and then sutures it securely to the patient’s skin.

The practitioner confirms placement by aspirating the catheter. Resistance indicates correct placement in the pleural space; aspirated blood means that the catheter probably is misplaced in a blood vessel, and aspirated air means that it’s probably in a lung. The practitioner then orders a chest X-ray to verify placement and to detect such complications as pneumothorax.

After insertion, apply a sterile occlusive dressing over the insertion site to prevent catheter dislodgment. Monitor the patient’s vital signs after the procedure at an interval determined by your facility or by the patient’s condition; no evidence-based research is available to indicate best practice for frequency of vital signs monitoring.² Screen for and assess the patient’s pain using facility-defined criteria that are consistent with the patient’s age, condition, and ability to understand. Treat the patient’s pain, as needed and ordered, using nonpharmacologic, pharmacologic, or a combination of approaches. Base the treatment plan on evidence-based practices and the patient’s clinical condition, past medical history, and pain management goals.³