Nursing Field Notes / Nursing Core · Med-Surg Course

Bedside Procedures 🩻

Lumbar puncture · thoracentesis · paracentesis · bronchoscopy · EGD

NG-400 Nursing Core ADHD-friendly visual edition

These five come up constantly and they all follow the same shape: consent and position before, monitor during, and one specific complication after. Learn the position and the complication for each and most of the questions answer themselves.

Lumbar punctureFlat 4 to 12 h after · headache is the complication

ThoracentesisSitting, leaning forward · pneumothorax after

ParacentesisEmpty the bladder first · hypovolemia after

EGDNPO until the gag reflex returns · perforation after

🧨 What starts it

Four figures drawn in the position each procedure needs - sitting forward over a table, curled on the side, flat with the bladder emptied, side-lying - with the complication each is known for underneath. — The position is the single most tested detail, and it is different for every one of them. Swipe it sideways if it is cut off, or tap to open it full size.

The same four steps every time

Before: signed consent, allergies, coagulation studies, hold anticoagulants, baseline vital signs, empty the bladder, explain the position.
Position: the single most tested detail. It differs for every procedure.
During: hold still, monitor vital signs and oxygen saturation, watch the level of consciousness, support and coach her.
After: vital signs on a schedule, dressing site check, and the one complication that procedure is known for.

What always applies

Consent is signed before sedation, never after.
Coagulation studies and platelet count on anything that punctures.
Mark and check the site; a rising dressing saturation is bleeding.
Label specimens at the bedside, in front of the patient.
Post-procedure vital signs: every 15 minutes × 4, then per policy.

The nurse’s job in consent

The provider explains the procedure, the risks and the alternatives. The nurse witnesses the signature and confirms she understands. If she cannot explain it back, stop and call the provider. Do not fill the gap yourself.

🔎 What you will see

Lumbar puncture — CSF from the spinal canal

Position: side-lying, knees to chest, chin tucked — a C shape. Or sitting, leaning over a table.
Empty the bladder first.
After: lie flat 4 to 12 hours and push fluids.
The complication: post-dural-puncture headache — positional, worse sitting up, better lying flat. Treat with flat bed rest, fluids, caffeine, and a blood patch if it persists.
Report: leaking clear fluid at the site, numbness or weakness in the legs, fever, neck stiffness.
Contraindicated when intracranial pressure is raised — removing fluid from below can herniate the brain downwards.

Thoracentesis — fluid from the pleural space

Position: sitting up, leaning forward over a bedside table, arms resting on a pillow. It widens the intercostal spaces.
Do not cough or move while the needle is in.
No more than 1000 mL at once — faster than that risks re-expansion pulmonary edema.
The complication: pneumothorax. Sudden dyspnea, sharp chest pain, absent breath sounds on that side, tracheal deviation. A chest x-ray afterwards is routine.
Lie her on the unaffected side afterwards.

Paracentesis, bronchoscopy and EGD

Paracentesis — fluid from the peritoneal cavity. Sitting upright or high Fowler’s. Empty the bladder first so the needle cannot hit it. The complication: hypovolemia — removing liters drops the blood pressure. Measure abdominal girth and weight before and after, watch for tachycardia and hypotension.
Bronchoscopy — the throat is sprayed with local anesthetic. Nothing by mouth until the gag reflex returns. The complications: laryngospasm, bleeding, and a small amount of blood-streaked sputum which is expected. Frank blood is not.
EGD — same throat spray, same gag-reflex rule. The complication: perforation — sharp chest or abdominal pain, fever, dysphagia, subcutaneous emphysema (crackling under the skin of the neck). Report it immediately.
Bone marrow and liver biopsy — pressure to the site, then lie on the right side after a liver biopsy to compress it. Bleeding is the risk in both.

🩺 What you do

Positions, side by side

Lumbar puncture — side-lying curled into a C, or sitting leaning forward
Thoracentesis — sitting, leaning forward over a table
Paracentesis — sitting upright, bladder emptied
Bronchoscopy — supine or semi-Fowler’s, then side-lying after
EGD — left lateral
Liver biopsy — supine with the right arm above the head during; right side-lying after

After any of them, report

Rising or new pain, especially sharp or pleuritic
Shortness of breath or a falling oxygen saturation
Dropping blood pressure or a rising heart rate
Bleeding through the dressing, or a growing hematoma
Fever
Any change in level of consciousness

The three that are pure recall

Flat after a lumbar puncture. Sitting up brings the headache on.
Chest x-ray after a thoracentesis. You are looking for a pneumothorax.
Bladder empty before a paracentesis. A full bladder is in the needle’s way.

⚡ Quick recall

Lumbar punctureFlat 4 to 12 h after · headache is the complication

ThoracentesisSitting, leaning forward · pneumothorax after

ParacentesisEmpty the bladder first · hypovolemia after

EGDNPO until the gag reflex returns · perforation after

Position for a thoracentesis?

Sitting up and leaning forward over a bedside table. It opens the intercostal spaces.

How long does she lie flat after a lumbar puncture, and why?

4 to 12 hours, to prevent a post-dural-puncture headache.

What must be done before a paracentesis?

Empty the bladder, and record weight and abdominal girth.

What is the risk right after a paracentesis?

Hypovolemia — removing liters of fluid drops the blood pressure.

Why nothing by mouth after an EGD or bronchoscopy?

The throat was anesthetized. Wait for the gag reflex or she will aspirate.

Sharp chest pain and crackling under the neck skin after an EGD?

Perforation with subcutaneous emphysema. Report immediately, keep her NPO.