Paracentesis

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • New-onset ascites
  • To rule out infection
  • Temporary relief of symptomatic tense ascites
  • Symptomatic relief in patients with diuretic-resistant ascites
CONTRAINDICATIONS

Absolute Contraindications

  • Acute abdomen requiring immediate surgery
  • Coagulopathy with disseminated intravascular coagulation or evidence of fibrinolysis

Relative Contraindications

  • Severe bowel distention
  • Previous abdominal surgery
  • Pregnancy
  • Distended bladder
  • Obvious infection at the intended site of needle insertion
EQUIPMENT

Use a commercially prepared kit or the following equipment:

  • Skin-cleansing solution
  • Sterile gloves and mask, sterile drapes
  • Sterile marking pen
  • 1% or 2% lidocaine with or without epinephrine
  • 5-mL syringe for anesthetic
  • 20-mL syringe for diagnostic paracentesis
  • 50-mL syringe and 3-way stopcock, if stopcock technique is used
  • 18-gauge, 1½- to 3-inch needle
  • 25- or 27-gauge, 1½-inch needle for skin anesthesia
  • Sterile IV tubing and 1-L vacuum bottles, if vacuum bottles are used
ANATOMY
  • Abdominal anatomy
    • The linea alba is the junction of the aponeuroses of the abdominal wall muscles.
    • The epigastric arteries and veins lie adjacent and parallel to the linea alba.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Educate the patient about signs of potential complications.
  • Plan for follow-up to discuss the results of any tests performed.
  • A brief observation period of 1 hour is appropriate while vital signs are monitored.
  • Obtain ascitic fluid studies as indicated:
    • Cell count.
    • Bacterial culture.
    • Concurrent serum and ascitic fluid albumin.
    • Consider glucose, LDH, amylase, Gram stain, cytology, triglyceride levels, AFB smear, AFB RNA polymerase chain reaction, and AFB culture, as indicated.
COMPLICATIONS
  • Perforation of viscous organ
  • Lacerations of major vessels
  • Abdominal wall hematoma
  • Infection (local or intraperitoneal)
  • Persistent ascitic fluid leak
  • Bladder perforation
RESULT ANALYSIS
  • If cell count values are normal (<250 white blood cells/mm3), the likelihood of infection is low. If the cell count is elevated, a confirmatory culture is required, but antibiotics would be initiated empirically.
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