Why is paracentesis done

Step 1. The anatomy of the abdominal wall is shown. The insertion sites may be midline or through the oblique transversus muscle, which is lateral to the thicker rectus abdominus muscles. Step 2. Place the patient in the horizontal supine position, and tilt the patient slightly to the side of the collection usually the left lower quadrant. Slightly rotate the hip down on the table on the side of needle insertion to make that quadrant of the abdomen more dependent.

The insertion sites are shown. Step 3. Prep the skin with povidone-iodine or chlorhexidine solution, and allow it to dry while applying sterile gloves and a mask see Appendix E : Skin Preparation Recommendations. Step 4.

Center the sterile drape about one third of the distance from the umbilicus to the anterior iliac crest. Step 5. A 2-inch needle is then inserted perpendicular to the skin to infiltrate the deeper tissues and peritoneum with anesthetic. Step 6. The nondominant hand then stretches the skin to one side of the puncture site, and the needle is further inserted to create a Z tract. Step 7. Release the pressure on the skin after the introducer enters the peritoneum. Advance the catheter into the abdominal cavity.

Step 8. Remove the introducer, and attach the syringe. Draw the fluid into the syringe. If no fluid returns, rotate, slightly withdraw, or advance the catheter until fluid is obtained. If still no fluid returns, abort the procedure, and try an alternative site or method. Ascites fluid may be removed by attaching a three-way stopcock or one-way valve, a cc syringe to one arm, and drainage tubing and bag to the other arm. If lavage is desired, such as for detecting hemoperitoneum after trauma, connect intravenous tubing to the three-way stopcock.

Remove excess fluid and then infuse to 1, mL of Ringer lactate or normal saline into the abdominal cavity. Gently roll the patient from side to side. Then, remove the fluid as described above or using a trap-suction arrangement.

Step 9. After the procedure, gently remove the catheter, and apply direct pressure to the wound. Observe the characteristics of the fluid, and send it for the appropriate studies.

If there is a scar, the paracentesis can be done blindly at a location away from the scar. If choosing a needle insertion site in the left lower quadrant, partially roll the patient onto his or her left side to allow the fluid to pool in the area.

Alternatively, position the patient in a lateral decubitus position. In this position, the air-filled bowel loops float up. The linea alba is the midline fibrous band the runs vertically from the xiphoid process to the pubic symphysis. This fibrous band does not contain important nerves or blood vessels. In patients with obvious and a large amount of ascites, locate an insertion site at the midline between the umbilicus and the pubic bone, about 2 cm below the umbilicus.

Locate an alternative site in the left lower quadrant, eg, about 3 to 5 cm superior and medial to the anterior superior iliac spine. If choosing the left lower quadrant site, roll the patient partially onto the left side to allow the fluid to pool in the area.

The insertion site should be lateral enough to avoid the rectus sheath, which contains the inferior epigastric artery. Alternatively, place the patient in a lateral decubitus position. In this position, the air-filled bowel loops float up, migrating away from the point of entry, which should be down in the fluid-filled region.

The left lateral decubitus position with needle insertion in the left lower quadrant is preferred by some physicians because the cecum may be distended with gas in the right lower quadrant. To choose a needle insertion site, carefully percuss, because dullness to percussion confirms the presence of fluid.

If needed, use ultrasound to identify a site, confirming the presence of ascitic fluid and the absence of overlying bowel. Prepare the area with a skin cleansing agent, such as chlorhexidine or povidone iodine, and apply a sterile drape while wearing sterile gloves. Using a gauge needle, place a wheal of local anesthetic over the insertion point. Switch to a larger or gauge needle and inject anesthetic progressively deeper until reaching the peritoneum, which should also be infiltrated because it is sensitive.

When the needle is advanced, maintain constant negative pressure to ensure lidocaine is not injected into a blood vessel. For diagnostic paracentesis, select an to gauge 1. For therapeutic paracentesis, select an to gauge 1. Smaller-gauge needles lessen the risk of complications, such as ascitic fluid leakage, but take longer to complete therapeutic paracentesis. Insert the needle perpendicular to the skin at the marked site. Alternatively, insert the needle using the Z-track method, which can be done in several ways.

Request an Appointment. Paracentesis for Ascites Ascites frequently occurs with cirrhosis of the liver, and it develops when the liver begins to fail. During the Procedure Paracentesis generally takes about 20 to 30 minutes. After the Procedure There are several tests that can be done using the abdominal fluid that has been removed. Your doctor may want to have one or more of the following tests performed: Culture. This can be done to determine whether infection is present.

If abnormal cells are in the fluid, they may be cancerous. Cell counts. High white blood cell count may indicate inflammation, infection or cancer. Increased white blood cell count and a high amount of polymorphonuclear leukocytes PMN may point to a specific infection called spontaneous bacterial peritonitis SBP. Decreased glucose levels could be associated with infection. How a paracentesis is done. Potential side effects. What the results mean.

What happens if the result is abnormal. Special considerations for children. References American Association for Clinical Chemistry. Lab Tests Online: Peritoneal fluid analysis. Cope DG. Malignant effusions.

Cancer Nursing: Principles and Practice. Sudbury, MA: Jones and Bartlett; pp. Shlamovitz GZ.