Paracentesis

PATIENT ALERT:
Paracentesis is contraindicated in a patient with an acute disorder of the abdomen that requires immediate surgery. Both coagulopathies and thrombocytopenia are considered relative contraindications. Coagulopathy should preclude paracentesis only when there is clinically evident fibrinolysis or clinically evident disseminated intravascular coagulation. Caution should be used when paracentesis is performed in patients with severe bowel distention, previous abdominal surgery (especially pelvic surgery), pregnancy (use open technique after first trimester), distended bladder that cannot be emptied by a Foley catheter, or obvious infection at the site of intended insertion (cellulitis or abscess).

PRE - PROCEDURE:
  • Verify presence of signed and witnessed consent
  • Check lab results and report abnormal valuesor deviations from baseline to the Physician
  • Assess:  breat sounds, pulse ox reading, V/S and document
  • Decompress the bladder, either by having the patient void or by inserting a Foley catheter.
  • Place the patient in the supine position (may tilt to side of collection slightly for improved fluid positioning).

PROCEDURE:
  • Wash hands and put on mask.
  • Assist in preparing equipment and sterile field.
  • Assist physician or advanced practice nurse to cleanse insertion site with chlorhexidene
  • Apply sterile drapes to outline the area to be tapped.
  • Assist physician or advanced practice nurse to draw up local anesthetic (lidocaine with epinephrine preferred).
  • Assist in collection of peritoneal fluid for laboratory analysis.
  • Assist in attaching syringes or stopcock and tubing and gently aspirate or siphon fluid by gravity or vacuum into collection device. Drains may be left in and allowed to drain for 6 to 12 hours.  NOTE: Most patients have a limit of aspiration to 2-3 liters of fluid;  however, patients with cirrhotic ascites may have 8-10 liters removed.
  • Every 15 minutes monitor and document V/S, LOC, pain scale after each liter of fluid removed .  Monitor more frequently as patient condition warrents/changes from baseline.
  • After the fluid and catheter are removed, apply pressure to the wound. If the wound is still leaking fluid after 5 minutes of direct pressure, have the puncture site sutured and apply a pressure dressing. If there is significant leakage, apply a stoma bag over the site until drainage becomes minimal.
  • Apply sterile dressing to wound site.
  • Dispose of equipment and soiled material in appropriate receptacle.
  • Wash hands.
  • Document in patient record.

POST-PROCEDURE:
  • Monitor V/S, pulse ox and paracentesis site every 15 minutes until stable
  • Monitor for S&S of bleeding;  monitor urine output, skin temp and moisture, abdomen for rigidity, change in sensorium.  Also monitor serum potassium and protein levels (these electrolytes are commonly lost)
  • Send specimens to labs as ordered
  • Document all monitored assessments

PREVENTION OF COMPLICATIONS:
  • Administer meds and/or blood products as ordered
  • Observe for peritonitis, peritoneal bleeding, hypovolemia and shock(due to fluid shift).  Replacement albumin or fluids may prevent hypotension, oliguria, hyponatremia and shock.

PATIENT TEACHING:
  • Explain what to expect and importance of remaining immobile during procedure
  • Inform patient and family of S&S to report to nurse, MD
  • Explain site care - may remove bandage after one day and shower.  Keep site dry and open to air as long as site is not draining

Document teaching and understanding
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