Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Thoracentesis


Related Terms

  • Pleural Fluid Aspiration
  • Pleural Tap
  • Pleurocentesis
  • Thoracocentesis

Specialists

  • Critical Care Internist
  • Pulmonologist
  • Thoracic Surgeon

Comorbid Conditions

Factors Influencing Duration

The underlying cause of the pleural fluid accumulation may influence the length of disability.

Medical Codes

ICD-9-CM:
34.91 - Thoracentesis

Overview

A thoracentesis is an invasive procedure during which a needle is inserted through the chest wall into the pleural cavity (the potential space between the membrane lining the chest wall [parietal pleura] and the membrane surrounding the lungs [visceral pleura]) to remove accumulated pleural fluid. Thoracentesis is performed to diagnose a condition, provide therapeutic benefit, or both.

Source: Medical Disability Advisor



Reason for Procedure

Diagnostic thoracentesis is performed to determine the cause of abnormal fluid accumulation (pleural effusion) between the pleurae. The various causes of pleural effusion can be identified via the analysis of the fluid, and include infections, pulmonary hypertension, neoplasms, heart failure, kidney disease, and cirrhosis. As a diagnostic aid, thoracentesis can be used to identify an unknown infection or one that is not responding to treatment. If an infection is suspected, a culture of the fluid with antibiotic sensitivity testing is often done to determine the presence of microorganisms and its antibiotic sensitivity. Other conditions for which diagnostic thoracentesis may be used include leakage of blood into the pleural cavity (hemothorax), inflammation of the pancreas (pancreatitis), blood clot in the artery of the lungs (pulmonary embolism), thyroid disease, asbestos-associated pleural effusion, drug reactions, and collagen vascular diseases.

Therapeutic thoracentesis is performed to relieve breathing difficulties by removing the excess fluid caused by pleural effusion. It may be helpful in such conditions as heart failure, malignancy, inflammations, infections, or effects associated with pneumonia. Additionally, sometimes it can be used to introduce different agents (e.g., sclerosing agents or agents for prevention/inhibition of cancers) directly into the pleural cavity once the fluid has been removed.

Source: Medical Disability Advisor



How Procedure is Performed

In order for the procedure to be performed correctly, the pleural effusion must be localized by either a physical examination (which would reveal dull sound on percussion where the fluids are located), chest x-rays, or sometimes ultrasound, computed tomography (CT) scan, or fluoroscopy. Additionally, blood tests might be done to determine if the individual has any problems with blood clotting.

Once the area with pleural effusion is identified, the procedure is typically performed while the individual is in a sitting position. A needle is inserted into the body from the back, at the upper border of one of the lower ribs (usually 5 to 10 cm away from the spine and below the point where the dull sounds were heard on percussion). Local anesthesia is then applied to the skin and tissues under the skin. Once pleural fluid is found on aspiration, the needle is changed to a needle with a larger bore (inner circumference) so that the fluid can easily be drawn out through connecting tubing and into a container. Usually around 100 ml of fluid is withdrawn slowly if a diagnostic thoracentesis is being performed, and up to 1,500 ml or more (but not exceeding 1,500 ml/day) for a therapeutic thoracentesis.

Once the needle is withdrawn from the chest after the procedure is completed, a small bandage is applied to the puncture site, and the individual may need to lie on his or her side for about an hour or longer to facilitate the sealing of the puncture site. Once the procedure is completed, it is usually followed by a chest x-ray to make sure no complications such as collapsed lung (pneumothorax) have developed as the result of thoracentesis. The x-ray will also help to demonstrate the effectiveness of a therapeutic thoracentesis, and may reveal lung abnormalities that had been hidden by the accumulated fluid.

This procedure is not routinely performed if the individual cannot cooperate (due to loss of consciousness, anxiety, compromised mental state, or combativeness), has grossly abnormal blood clotting, has a lower than normal number of platelets (thrombocytopenia), or has an unstable respiratory or cardiac condition.

Source: Medical Disability Advisor



Prognosis

Diagnostic thoracentesis will give the doctor information about the condition of the pleural cavity. It will also help to reveal the nature of any pleural disease. The outcome of tests guides the physician in making an appropriate diagnosis of the underlying cause for the increased fluid. The results of the procedure will guide the selection of treatment for the pleural effusion.

The use of therapeutic thoracentesis as treatment for pleural effusion generally relieves the symptoms, but it may not always be curative (e.g., in malignancy or congestive heart failure). Therefore, outcomes will vary, depending on the condition responsible for development of pleural effusion.

Source: Medical Disability Advisor



Complications

Possible complications of the procedure include pneumothorax, re-accumulation of the fluid, pulmonary edema, hemothorax, infection, respiratory distress, puncture of the spleen or liver, air embolism, and fainting (simple or vasovagal syncope). Death may also occur, but it is extremely rare.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions or accommodations depend on the individual's job requirements. Strenuous activity or heavy lifting will have to be modified temporarily.

Risk: No job would put an individual at increased risk of needing a thoracentesis procedure.

Capacity: Thoracentesis would have no long term impact on capacity. The underlying condition that necessitated the treatment would be important to review.

Tolerance: Thoracentesis would have no long term impact on tolerance, although, as with capacity, the underlying condition that necessitated the treatment would be important to review.

Source: Medical Disability Advisor



Maximum Medical Improvement

7 days.

Source: Medical Disability Advisor



References

Cited

Sachdeva, A. "Thoracentesis and Thoracic Ultrasound: State of the Art in 2013." Clinics in Chest Medicine 34 (2013): 1-9.

General

Tamura, M., Yasuhito Ohta, and H. Sata. "Thorascopic Appearance of Bilateral Spontaneous Pneumothorax." Chest 124 6 (2003): 2363-2371.

Source: Medical Disability Advisor






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