Paracentesis

DOCUMENTATION

EQUIPMENT

  • Paracentesis Kit
  • chlorhexidine
  • sterile gauze
  • sterile drape
  • 6mL syringe
  • Needles for injection
  • Lidocaine
  • 18-gauge needle +/- catheter
  • 35mL syringe for aspiration
  • Drainage bag
  • Sterile occlusive dressing
  • Specimen tubes
  • Ultrasound
  • Sterile Probe Cover
  • Sterile Gloves

PROCEDURE

  • Positioning: Patient is placed supine in the bed slightly recumbent to the side of insertion.
  • There are three sites that are recommended for needle-insertion. These sites include
  1. LLQ between the ASIS and umbilicus -the best choice-
  2. RLQ between the ASIS and umbilicus
  3. Midline, 2 cm below the umbilicus
  • The lateral approach is preferred because the ascitic fluid is deeper, but needle must be inserted lateral to the rectus sheath avoiding the inferior epigastric artery.
  • Bedside ultrasound should be used to evaluate the fluid and find the most appropriate place for insertion.
  • Mark the chosen area.
  • Sterile gloves, gown and face shield should be used
  • Clean the area with Chlorhexadine.
  • Apply the sterile drape.
  • With the anesthetic needle with lidocaine place a wheal at the entry site and then move into the deeper tissues all the way to the peritoneal cavity. If peritoneal fluid is aspirated, pull back slightly and inject only the peritoneum. Insert 18 gauge needle with 35mL syringe at the marked site just below the epidermis.
  • Z-tract technique: The skin is pulled 2 cm caudally before going through the subcutaneous tissue and peritoneum so that the tract with slide over itself and reduce leaking
  • Advance the needle slowly with negative pressure until the needle enters the peritoneal cavity. Once peritoneal fluid is obtained, continue aspirating fluid or slide the catheter over the needle, if catheter used, and then remove the needle.
  • The catheter must be covered to prevent the entry of air and drainage bag can be placed
  • No more then 3-5L should be removed at one time.
  • Once the fluid is taken out remove the needle/catheter and apply dressing.
  • The peritoneal fluid should sent for:
    • Albumin
    • Cell count and differential
    • Culture including mycobacterial
    • Serum albumin should be measured as well
    • Also consider: Protein, LDH, Glucose, CEA, Alkaline Phosphatase, Amylase, Triglycerides

PROCEDURE NOTE

Date:

Indication: Ascites

Resident:

Attending:

Consent was obtained and a time-out was completed verifying correct patient, procedure, site, and positioning. The patient was placed in appropriate dependent position for paracentesis. The patient’s right(?)left abdomen was prepped below the umbilicus and draped in sterile fashion. 1% Lidocaine was(?)was not used to anesthetize the surrounding skin area. Ultrasound was(?)was not used to identify the fluid and observe the needle entering the peritoneum. The needle was introduced into the peritoneal cavity. Appropriate fluid return was obtained and fluid was(?)was not removed for study. The needle was(?)was not attached to a drainage bag and ___mL of fluid were removed. The needle was then bandaged in place(?)removed. The patient tolerated the procedure well and there were no complications. Blood loss was minimal.