1 Determine the state(s) where you wish to obtain a license and contact the state board(s) of dentistry to obtain specific licensure requirements and a sample application. 2  Click here for requirements by state.3  Take the NBDE Part I administered by the ADA Joint Commission on National Dental Examinations (JCNDE). Determine the state(s) where you wish to obtain a license and contact the state board(s) of dentistry to obtain specific licensure requirements and a sample application. 2  Click here for requirements by state. 3  Take the NBDE Part I administered by the ADA Joint Commission on National Dental Examinations (JCNDE).
Guide. Thoracentesis is a procedure to remove fluid from the space between the lungs and the chest wall called the pleural space. It is done with a needle (and sometimes a plastic catheter) inserted through the chest wall.Ultrasound pictures are often used to guide the placement of the needle.ormally only a small amount of pleural fluid is present in the pleural space. A buildup of excess pleural fluid (pleural effusion) may be caused by many conditions, such as infection, inflammation, heart failure, or cancer. If a large amount of fluid is present, it may be hard to breathe.
If you are unable to seat the patient due to hemodynamic status, mental status or because of tubes and indwelling lines, the Thoracentesis has to be done in the supine position. Turn the patient on his side and bring his back to the edge of the bed. You will be able to accomplish the Thoracentesis in this position. Be aware that the dependent diaphragm moves up. Let me show you a lateral decubitus chest x-ray to demonstrate the upward movement of the dependent diaphragm. Select the 5th or 6th interspace to avoid possible injury to the diaphragm.