The LSUHSC New Orleans
Emergency Medicine Interest Group

Presents

The Student Procedure Manual


Paracentesis

by Aruna Akundi with
Wayne Berkowitz

Indications
Contraindications (all relative)
Prerequisites
Equipment
Procedure
Follow-up
Complications
References

Indications

Contraindications (all relative)

Prerequisites

Equipment

Procedure

  1. Place patient in supine or lateral decubittis position.
  2. The ideal puncture site is in the left lower quadrant of the abdomen, lateral to the rectus abdominis muscle , in the midclavicular line, inferior to the umbilicus.
  3. Alternate sites may be preferred depending on the location of the fluid and the purpose of the tap.
  4. Point of entry should remain lateral to the rectus abdominis muscle to avoid injury to the inferior epigastric artey and vein.
  5. Avoid the upper abdominal quadrants in case of undetected hepatosplenomegaly.
  6. Avoid visible, collateral venous channels (caput medusa) on the abdominal wall.
  7. Avoid known sites of abdominal surgery where adhesions may be present.
  8. After appropriate sterile preparation, infiltrate 1% Lidocaine subcutaneously to the peritoneum.
  9. Refer to the Intramuscular Injection procedure to perform a "Z seal" to prevent persistent ascitic leakage at site.
  10. Insert an 18- or 20- gauge short beveled spinal needle attached to a syringe through the abdominal wall. Different sizes and types of needles or catheters may be used depending on the purpose of paracentesis.
  11. Withdraw at least 50ml of ascitic fluid for adequate study. Some situations may necessitate larger quantities ranging from I to 3 liters, as in tense ascites.

*Note: Special paracontosis needles, "needle-over-catheter", can be used for this procedure and are preferred in that the risk of parenchymal injury is reduced.

Follow-up

Complications

References

  1. Glauser JM. Paracentesis. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1991: 674-678.
  2. Napolitano LM. Paracentesis. In: Rippe JM, et al. eds. Procedures and Techniques in Intensive Care Medicine. Philadelphia, Pa: Little, Brown and Co; 1995: 207-209.

 


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