Abdominal paracentesis

Abdominal paracentesis

1. ABDOMINAL PARACENTESIS

2. INTRODUCTION The accumulation of large amount of fluid within the peritoneal cavity exerts pressure on the diaphragm and abdominal organs and vasculature, leading to respiratory compromise and increased work of breathing. Paracentesis relieves intra abdominal and diaphragmatic pressures, diminishing the work of breathing.

3. DEFINITION “ Paracentesis is a procedure in which fluid is removed from the peritoneal cavity for diagnostic and therapeutic purposes .”

4. PURPOSES 1.To obtain fluid samples from the peritoneal space for diagnostic examination. 2. Evacuate fluid from the peritoneal space. 3. Alleviate respiratory compromise related to pressure on the diaphragm caused by ascetic fluid.

5. INDICATIONS

6. New onset ascites or ascites of unknown origin. Patient with a known ascites who has fever, abdominal pain, hypotension or encephalopathy. Symptomatic treatment of large ascites.

7. CONTRAINDICATIONS Uncooperative patients Uncorrected bleeding diathesis Acute abdomen that requires surgery Intra-abdominal adhesions Distended bowel Abdominal wall cellulitis at the site of puncture Pregnancy

8. PREPARATION OF THE ARTICLES

9. Sterile gloves, gown and mask Povidone iodine solution Sterile drape Lidocaine 2% 5cc syringe and needle 25 gauge needle 10cc syringe-2

10. 50cc syringe-2 Trocar with stylet Sterile tubes for specimen Surgical blade Three way stop cock Sterile 1l collection bottle Gauze and tape

11. 4 STEPS OF THE PARACENTESIS PROCEDURE ..

12. 1. Ultrasound scan before the procedure 2. Patient preparation 3. Procedure 4. Laboratory results

13. Ultrasound scan before the procedure What is the distance from the skin to the fluid? Usually 1 cm. It gives an idea how deep you have to go with the needle before getting fluid in the syringe.

14. PATIENT PREPARATION Explain the rba (risks, benefits, alternatives) Informed written consent urinate before the procedure or use a folley’s to empty the bladder. Position the patient in the bed with the head elevated at 45-60 degrees to allow fluid to accumulate in lower abdomen.

15. POSITIONING Position the patient in the bed with the head elevated at 45-60 degrees To allow fluid to Accumulate in lower abdomen .

16. PUNCTURE SITE…

17. 2 cms below the umbilicus in the midline (through the linea alba) 5 cms superior and medial to the anterior superior iliac spines on either side.

18. Position the patient and prepare the skin around the entry site with an antiseptic solution .

19. DRAPING.

20. ANESTHESIA : 4-5 mL of lidocaine along the catheter insertion tract,anesthetise all the way down to the peritoneum .

21. Use the No. 11 scalpel blade to make a small nick in the skin to allow an easier catheter passage.

22. Insert the needle directly perpendicular to the selected skin entry point. Continuously apply negative pressure to the syringe as the needle is advanced. Upon entry to the peritoneal cavity , loss of resistance is felt and ascitis fluid can be seen filling the syringe.

23. Use one hand to firmly anchor the needle and syringe securely in place to prevent the needle from entering further the peritoneal cavity Stabilization of needle and syringe

24. While holding the stopcock, pull the needle out. Attach the 50-ml syringe to the 3-way stopcock and aspirate to obtain ascitis fluid.

25. Connect one end of the fluid collection tubing to the stopcock and the other end to a vacuum bottle or a drainage bag .

26. Documentation Consent    Indications and contraindications for procedure Procedure, including prep, anesthetic, needle size, amount of fluid drawn off, character of fluid Any complications or “none”      Who was notified of any complication (family, attending MD)

27. NURSING CONSIDERATIONS NURSING CONSIDERATIONS

28. Fluid specimen for laboratory analysis. Record amount ,characteristics of fluid , number of specimens sent to laboratory. Patient’s condition during treatment

29. Check vital signs every half hour for two hours, every hour for four hours and every four hour for 24 hours. Watch for leakage or scrotal edema after paracentesis. Observe the site for bleeding Replace the articles

30. LABORATOY ANALYSIS

31. Gram stain (bacterial peritonitis.) Cell count (elevated counts may suggest infection) Bacterial culture Total protein level Triglyceride levels (elevated in chylous ascites) Bilirubin level (may be elevated in bowel perforation) Glucose level Amylase level (elevation suggests pancreatic source)

32. COMPLICATIONS

33. Perforation of bowel or bladder. Local or systemic infection. Hypovolemia, hypotension. Bleeding from paracentesis site. Ascetic leak from paracentesis site.

34. THANK U ALL