What is the most important nursing assessment after a thoracentesis procedure?

Thoracentesis is the insertion of a needle through the chest wall to remove fluid from the pleural space. Main complications: (1) Pneumothorax — air enters the pleural space, possibly causing lung collapse; signs include sudden shortness of breath, sharp chest pain, decreased or absent breath sounds on affected side, tracheal deviation (large pneumothorax), hypoxia; (2) Bleeding; (3) Re-expansion pulmonary edema (if too much fluid removed too quickly); (4) Infection. Post-procedure nursing: (1) Position the client upright or on the unaffected side initially; (2) Monitor respiratory status frequently (vital signs every 15 minutes for 1 hour, then every hour, then per protocol); (3) Auscultate breath sounds bilaterally and compare to pre-procedure; (4) Monitor for shortness of breath, chest pain, hemoptysis, hypoxia; (5) Chest x-ray usually ordered to verify lung expansion and rule out pneumothorax; (6) Document fluid removed (color, character, amount). Report sudden change in respiratory status immediately. The same vigilance applies after any chest procedure: central line insertion, lung biopsy, chest tube placement.