Ascitic tap procedure

Asitic tap procedure

1. ASCITIC TAP PROCEDURE PREPARED BY: GIANNE T.GREGORIO RN

2. LEARNING OBJECTIVES At the end of the discussion, nurses will be able to: Define Ascitic Tap Determine the grade of ascites and its treatment. Know the indications of ascitic tapping. Be f amiliarize with the procedure.

3. OUTLINE DEFINITION INDICATIONS EQUIPEMENT FOR ASCITIC TAP PRE-PROCEDURE PROCEDURE RECOMMENDATIONS REFERENCES

4. DEFINITION ASCITES  is the abnormal buildup of fluid in the abdomen. Technically, it is more than 25 ml of fluid in the peritoneal cavity. Symptoms may include increased abdominal size, increased weight, abdominal discomfort, and shortness of breath. Complications can include spontaneous bacterial peritonitis An ASCITIC TAP is a medical procedure where a needle is used to drain fluid that is trapped in an internal body cavity, most commonly the abdomen (belly).  

5. INDICATIONS To aid diagnosis of the cause of ascites or in the diagnosis or exclusion of Spontaneous bacterial peritonitis. A diagnostic paracentesis should be performed in all patients with new onset grade 2 or 3 ascites, and in all patients hospitalized for worsening of ascites or any complication of cirrhosis.

6. GRADE OF ASCITES DEFINITION TREATMENT 1 Mild ascites only detectable by ultrasound No treatment 2 Moderate ascites evident by moderate symmetrical distension of abdomen Restriction of sodium and diuretics 3 Large ascites with marked abdominal distension Large volume paracentesis followed by treatment as for (2)

7. Equipment required for ASCITIC TAP ( P aracentesis ) Ultrasound (ideally) Dressing trolley & sharps bin Sterile field Sterile dressing pack Sterile gloves 2% Chlorhexadine swabs Analgesia 10ml of 1% or 2% Lidocaine Orange (25G) needle (x1) Green ( 19G ) needle (x1) 10ml Syringe (x1) 20ml Syringe (x1) with green (19G) needle (x1) Specimen containers Blood culture bottles Dressing

8. CONTRAINDICATIONS Overlying infection choose another site CAUTIONS – but NOT contraindications Coagulopathy (INR>2.0) Attempt to correct INR to <1.5 if possible. Platelets<50 Thrombocytopenia and coagulopathy is often present in liver disease and though it is a caution, it not a contraindication to paracentesis or drainage The incidence of clinically significant bleeding is low; routine FFP or platelets is not indicated

9. CONTRAINDICATIONS Pregnancy Organomegaly Obstruction/ileus Distended bladder Abdominal adhesions

10. Pre-procedure Consent patient and explain procedure Consent for infection, bleeding, pain, failure, damage to surrounding structures (especially bowel perforation – rare), leakage Lie patient flat and examine clinically to confirm ascites Ultrasound area for insertion Define landmarks Aim for 1/3 to ½ of the way between the anterior superior iliac spine and the umbilicus avoiding vessels and scars

11. Procedure for Ascitic tap (PARACENTESIS) Position the patient supine in the bed with their head resting on a pillow. Select an appropriate point on the abdominal wall in the right or left lower quadrant, lateral to the rectus sheath. If a suitable site cannot be found with palpation and percussion consider using ultrasound to mark a spot. Clean the site and surrounding area with 2% Chlorhexadine and apply a sterile drape. Anaesthetise the skin with Lidocaine using the orange needle .

12. Procedure for Ascitic tap (PARACENTESIS) Anaesthetise deeper tissues using the green needle, aspirating as you insert the needle to ensure you are not in a vessel before infiltrating with lidocaine . Use a maximum of 10mls of Lidocaine . Take a clean green needle and 20ml syringe and insert through the skin advancing and aspirating until fluid is withdrawn Aspirate 20ml Remove needle and apply sterile dressing

13. RECOMMENDATION Ensure patient has valid consent. Obtain accurate assessment and patient history Always send the most fluid to cytology, especially if malignancy is suspected. The more fluid sent, the higher the diagnostic yield. Never dispose of unused fluid, put it in an extra pot and add to the cytology sample .

14. REFERENCES https://www.insideradiology.com.au/ascitic-tap / http://www.oxfordmedicaleducation.com/clinical-skills/procedures/paracentesis/