PARACENTESIS
Removal of abdominal fluid is of value in evaluating patients with ascites of new onset or unknown etiology, and provides symptomatic relief in patients with known disease or in the setting of a decompensating clinical state. Abdominal paracentesis is a simple procedure that may be performed rapidly and with a minimum of equipment.
Indications
1. New onset ascites or ascites of unknown origin
2. Patients with ascites of known etiology who may have a decompensation clinical state as indicated by fever, painful abdominal distention, peritoneal irritation, hypotension, encephalopathy or sepsis
3. Suspected malignant ascites
4. Peritoneal dialysis patients with fever, abdominal pain or other signs of sepsis (usually the paracentesis fluid may be removed directly from the patient’s dialysis catheter)
Contraindications
1. Uncorrected bleeding diathesis
2. Previous abdominal surgeries with suspected adhesions
3. Severe bowel distention
4. Abdominal wall cellulitis at the proposed site of puncture
Materials
1. Universal precautions materials
2. 1-liter vacuum bottles
3. Blood collection tubing, or a secondary IV tubing set
4. 18 gauge needle
5. Skin prep solution
6. Sterile draping
7. 1% or 2% lidocaine with epinephrine for local anesthesia
8. 5 cc syringe with 25 gauge needle for anesthesia infiltration
If available, a bedside ultrasound machine is an asset.
Preprocedure patient education
1. Obtain informed consent
2. Inform the patient of potential complications (infection, hypotension) and their treatment
3. Explain the major steps of the procedure
Procedure
1. Obtain relevant patient history, and perform a physical exam to document and localize ascitic fluid.
2. If ultrasound machine is available, scan patient to localize fluid collections, and perform the procedure under real-time ultrasound guidance.
3. Place patient in supine position, with head elevated 20-300. Select and mark a position on the abdominal wall for puncture (Figure 1)
Figure 1.
