Abdominal Paracentesis, Assisting
As a bedside procedure, abdominal paracentesis involves the aspiration of fluid from the peritoneal space through a needle or trocar and cannula inserted in the abdominal wall. Used to diagnose and treat massive ascites resistant to other therapies, the procedure helps to determine the cause of ascites while relieving the pressure it creates.
Abdominal paracentesis may also precede other procedures, including radiography, peritoneal dialysis, and surgery; detect intra-abdominal bleeding after a traumatic injury; and be used to obtain a peritoneal fluid specimen for laboratory analysis. The procedure must be performed cautiously in pregnant patients as well as in patients with bleeding tendencies, a severely distended bowel, or an infection at the intended insertion site.
Equipment
Tape measure ▪ sterile gloves ▪ mask ▪ gloves ▪ gown ▪ goggles ▪ linen-saver pads ▪ Vacutainer tubes ▪ two large Vacutainer bottles (1,000 mL or larger) ▪ sterile pressure dressing ▪ laboratory request forms ▪ antiseptic cleaning solution ▪ local anesthetic (multidose vial of 1% or 2% lidocaine with epinephrine) ▪ 4″ × 4″ sterile gauze pads ▪ sterile paracentesis tray ▪ sterile drapes ▪ marking pen ▪ 5-mL syringe with 21G or 25G needle ▪ Optional: alcohol sponge, 50-mL syringe, suture materials, salt-poor albumin.
If a preassembled tray isn’t available, you will need to gather the following sterile supplies: trocar with stylet, 16G to 20G needle, 25G or 27G 1½″ needle, 20G or 22G spinal needle, scalpel, no. 11 knife blade, three-way stopcock.
Implementation
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.4
Explain the procedure to the patient to ease his anxiety and promote cooperation. Reassure him that he should feel no pain, but that he may feel a stinging sensation from the local anesthetic injection and pressure from the needle or trocar and cannula insertion.
Make sure that an informed consent has been obtained and is documented in the patient’s medical record.5
Instruct the patient to void before the procedure. Or, insert an indwelling urinary catheter, if ordered, to minimize the risk of accidental bladder injury from the needle or trocar and cannula insertion.
Conduct a preprocedure verification process to make sure that all relevant documentation, related information, and equipment are available and correctly identified to the patient’s identifiers.6
Obtain and record baseline values: vital signs, weight, and abdominal girth. (Use the tape measure to measure the patient’s abdominal girth at the umbilical level.) Indicate the abdominal area measured with a felt-tipped marking pen. Baseline data will be used to monitor the patient’s status.
Position the patient supine or on his side to allow the fluid to pool in dependent areas.7
Expose the patient’s abdomen from diaphragm to pubis. Keep the rest of the patient covered to avoid chilling him.
Make the patient as comfortable as possible, and place a linen-saver pad under him for protection from drainage.
Remind the patient to stay as still as possible during the procedure to prevent injury from the needle or trocar and cannula.
Remove and discard your gloves. Perform hand hygiene. Put on sterile gloves, a gown, and goggles to prevent cross-contamination.1,2,3,8
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