DEFINITION

It is the removal of fluid from the abdominal cavity(peritoneum) to reduce intra-abdominal

tension in patient with respiratory compromise and tense ascites or obtain fluid for culture.it
is also called peritoneal tap.

PURPOSES
1. To drain and exudates in peritonitis for diagnostic purposes.
2. To study cell count,gram stain,microscopy and culture.
3. To remove fluid and instil air to create artificial pneumoperitoneum as treated for
pulmonary tuberculosis(TB) affecting base of lung.
4. To relieve pressure on abdominal and chest organs if a transudate collects as a result of
renal,cardiac or lung disease.

ARTICLES
A sterile tray containing
 Sponge holder forceps
 5ml syringe(for local anesthesia)
 20ml syringe(for aspiration of fluid)
 Betadine solution (to clean the site)
 Three way adapter and tubing
 Small bowls(to take cleansing solution)
 Specimen bottles,sterile dressing pack,cotton balls or gauze pieces.

A clean tray containing:

 Mackintosh and draw sheet.

 Injection 2% lignocaine(for local anesthesia)
 Intravenous set,spirit swabs.
 Kidney tray and paper bag

STEPS OF PROCEDURES
BEFORE THE PROCEDURE
Identify your patient, introduce yourself
 Explain the procedure to the patient and obtain a written informed consent, if
possible.
 Explain the indication, risks, benefits and alternatives.
• Prepare the appropriate equipment
• Ask the patient to urinate before the procedure to empty the bladder.
Position the patient in the bed with the head elevated at 45-60 degrees, tilt the patient
toward the site of paracentesis (allow fluid to accumulate in lower abdomen and air-filled
loops of bowel tend to float to the other site, this will minimize trauma to bowel).
• Ultrasound scan
 • To identify the presence of encysted ascites
• To avoid distended bladder, small bowel adhesions, large veins.
• How deep to insert the needle
The two recommended areas of abdominal wall entry for paracentesis are as follows: •
2 cm below the umbilicus in the midline
• 5 cm superior and medial to the anterior superior iliac spines on either side
Technique
• Explain what is going on while performing the procedure, this will alleviate the patient's
anxiety.
• Wear sterile gloves
• Clean the area with antiseptic solution in a circular fashion from the center out.
Apply the sterile drapes. You will place the opened parts of the kit on the drape
• Open the 16 G Angiocath and syringe place them on the sterile drapes. Place the 1-L
vacuum bottles nearby.
• Administer lidocaine at the insertion site
Use scalpel blade to make a small nick in the skin to allow an easier catheter passage
• Insert the needle in Z-technique
• Insert the needle directly perpendicular to the selected skin entry point. Slow insertion in
increments of 5 mm is preferred to minimize the risk of inadvertent vascular entry or
puncture of the small bowel.
Continuously apply negative pressure to the syringe as the needle is advanced. Upon
entry to the peritoneal cavity, loss of resistance is felt and ascitic fluid can be seen filling
the syringe .
• At this point, advance the device 2-5 mm into the peritoneal cavity to prevent
misplacement during catheter advancement.
• In general, avoid advancing the needle deeper than the safety mark that is present on most
commercially available catheters or deeper than 1 cm beyond the depth at which ascitic fluid
was noticed.
Use one hand to firmly anchor the needle and syringe securely in place to prevent the needle
from entering further into the peritoneal cavity
• Use the other hand to hold the stopcock and catheter and advance the catheter over the
needle and into the peritoneal cavity all the way to the skin
The self-sealing valve prevents fluid leak.
• Attach the 60-mL syringe to the 3-way stopcock and aspirate to obtain ascitic fluid and
distribute it to the specimen vials and send it to the lab for analysis
Connect one end of the fluid collection tubing to the stopcock and the other end to a
vacuum bottle or a drainage bag
• If the flow stops, kink or clasp the tubing to avert loss of suction, then break the seal and
manipulate the catheter slightly, then reconnect and see if flow resumes.
Post procedure
• Remove the catheter after the desired amount of ascitic fluid has been drained.
• Apply firm pressure
• Place sterile gauze a bandage over the skin puncture site.
• Ask the patient to lie for 4 hours and the nurse to check vital signs every hour for 4 hours
to avoid hypotension.
• Give 25 cc of albumin (25% solution) for every 2 liters of ascitic fluid removed.
Write a procedure note which documents the following:
• Patient consent
• Indications for the procedure
• Relevant labs, e.g. INR/PTT, platelet count
• Procedure technique, sterile prep, anesthetic, amount of fluid obtained, character of fluid,
estimated blood loss.
• Any complication
s • Lab tests requested. Color, pH, Protein, albumin, specific gravity, glucose, bilirubin,
amylase, lipase, triglyceride, LDH, Cell count total and differential, Culture &Sensitivity,
Gram stain, AFB, Cytology
Complications
• Persistent leak from the puncture site
• Abdominal wall hematoma
• Perforation of bowel
• Introduction of infection
• Hypotension after a large-volume paracentesis
• Dilutionalhyponatremia
• Catheter fragment left in the abdominal wall or cavity

HEALTH EDUCATION
 Take bath after 24 hours of the procedure
 Apply warm compresses to the affected area for comfort if needed.
 If the drainage site become red,tender,swollen,consult the physician immediately.
 Avoid lifting heavy weight.
 Take prescribed medicine continuously
 Eat light food for first 24 hours.
 Drink plenty of fluids.