Paracentesis Learning Module
This web page is composed of six sections designed to re-familiarize practitioners with the Paracentesis procedure.
Print all the necessary documents here or at other points throughout the module.
*Note: This module does not replace medical training and must be used in conjunction with clinical judgment. Acting practitioner is ultimately responsible for the safety of procedures.
Principle Risks
Rare Risks
-
Injury to intrabdominal organs~0.1 - 0.4% -
Intra-abdominal infection ~0.2% -
Vasovagal reaction -
Anaesthetic/sedative reactions - Print Consent Form
Contraindications
- Active skin infection over site
- Engorged cutaneous vessels over site
- Extremis
- Midline scars
- Disseminated Intravascular Coagulation
Precautions
- INR > 1.5
- Platelet < 50,000/mm3
- Organomegaly, bowel obstruction, intra-abdominal adhesions or distended urinary bladder
- Place NG tube to decompress bowel if obstruction
- Place Foley to decompress bladder if distended
There are no absolute contraindications for paracentesis, only parameters that increase the risk
Many patients have a degree of coagulopathy and/or thrombocytopenia. Routine administration of FFP for stable coagulopathy is not recommended
Print Procedure Note
1Positioning
- Patient should be supine in bed with his/her head slightly elevated
- The full abdomen should be exposed
2Landmark manually
- Percuss for dullness to demarcate ascites
- Landmark should be in the left or right lower quadrant
- Approximately 2 cm medial and 2-4 cm superior to the anterior superior iliac spine
- Needle MUST be inserted lateral to rectus sheath
3Visualize the effusion and remark needle insertion site
4Sterilizing and anaesthetizing
- Sterilize the area 3 times utilizing antiseptic
- Dress with sterile gloves and apply a sterile drape
- With a 25 gauge needle, inject a ‘wheel’ of lidocaine into the dermis overlying the prospective needle insertion site
- With a 20 gauge needle, anaesthetize the deeper tissues, intermittently aspirating, until pleural fluid is obtained
5Introduce the catheter device
- Use a scalpel to create a small nick in the skin and subcutaneous tissue where you will insert your paracentesis needle
- Introduce your catheter device where the chest wall has been previously anaesthetized utilizing the ‘Z-tract’ technique; intermittently aspirate while advancing until pleural fluid is obtained
- Advance the plastic catheter (without the needle component) until the black/blue demarcating line is no longer visible
6Obtaining fluid
- Turn the stopcock to the lock position and attach a 60 cc syringe.
- Turn the stopcock 90 degrees; withdraw fluid into the syringe and divide into specimen bottles (including aerobic/anaerobic bottles)
- For therapeutic paracenteses, attach a vacuum bottle to drain additional ascitic fluid
7Caution
- For large volume paracentesis (i.e. greater than 5-6 L), consider administration of albumin
- Dose: 6-8g IV albumin per litre of peritoneal fluid removed
- Stop/pause the procedure if patient develops significant abdominal pain, hemodynamic instability, or signs/symptoms of vasovagal reaction
8Post procedure care
- Turn stop-cock into locked position before withdrawing catheter device
- Place clean bandage over procedural site
- Order post-procedure vitals
- Documentation sheet must be in the chart!
9Caution
All specimens should be hand-delivered to their destinations
Videos:
Thomsen, Todd W., et al. “Paracentesis.” New England Journal of Medicine355.19 (2006): e21.
Kind thanks to CareFusion for their permission.