AbdominalparacentesisMinChenZhongnanHospital1LEARNINGOBJECTIVESKnowindicationsandcontraindicationsforabdominalparacentesisKnowtheproceduresofabdominalparacentesisCommandskillofparacentesis2Definition

AbdominalParacentesis（abdominocentesis）isaprocedureinwhichaneedleorcatheterisinsertedintotheperitonealcavitytoobtainasciticfluidfordiagnosticortherapeuticpurposes.3Indications

Diagnosticindications:New-onsetascites-Fluidevaluationhelpstodetermineetiology,differentiatetransudateversusexudate,detectthepresenceofcancerouscells,oraddressotherconsiderationsSuspectedspontaneousorsecondarybacterialperitonitisTherapeuticindications:

RespiratorycompromisesecondarytoascitesAbdominalpainorpressuresecondarytoascites(includingabdominalcompartmentsyndrome)4Contraindications

Anacuteabdomenthatrequiressurgeryisanabsolutecontraindication.Severethrombocytopenia(plateletcount<20×103/μL)andcoagulopathy(internationalnormalizedratio[INR]>2.0)arerelativecontraindications.5OtherrelativecontraindicationsPregnancyDistendedurinarybladderAbdominalwallcellulitisDistendedbowelIntra-abdominaladhesions6Equipment

AntisepticswabsticksFenestrateddrapeLidocaine1%,5-mLampuleSyringe,10mLInjectionneedles,22-gauge(two)Catheter,8F,over-the-needlewithclampandasyringeIntroducerneedle,20-gaugeDrainagebagorvacuumcontainerSpecimenvialsorcollectionbottles,3Gauze,4×4in.Adhesivedressing7Preparation：patient’smedicalhistory,Wearlabcoat,maskWashhands（6stepshandswashing)PrepareequipmentCheckthepatient’sinformation8Preprocedure:patienteducation

1.Explainthebenefits,risks,andalternativeoptionstothepatientorthepatient'srepresentative,

2.Informthepatientofpotentialcomplications(bleeding,infection,intra-abdomenorgansinjury,hypotension)andtheirtreatment

3.Explainthemajorstepsoftheprocedure4.Obtainsignedinformedconsent9Procedure:localizefluidcollections

1.Obtainrelevantpatienthistory,andperformaphysicalexamtodocumentandlocalizeasciticfluid(dullness).

2.Ifultrasoundmachineisavailable,scanpatienttolocalizefluidcollectionsSelectandmarkasiteontheabdominalwallforpuncture10InsertionsiteTherecommendedsiteapointonethirdofthewayalongalinedrawnfromtheanteriorsuperioriliacspinestotheumbilicus;11ApproachtoParacentesisEnsurethatthepatient'sbladderisemptyPosition:Placepatientinsupineposition,withheadelevated20-300.Sterilization:preparetheskinaroundtheentrysitewithanantisepticsolution(15cmx3timeswithBetadine)Draping:Applyasterilefenestrateddrapetocreateasterilefield12Localanesthesia-deeperinjection.raiseasmalllidocaineskinwhealaroundtheskininsertionsiteMakesuretoanesthetizeallthewaydowntotheperitoneum.Notethedepthatwhichtheperitoneumisentered.13InsertionInserttheneedledirectlyperpendiculartotheselectedskinentrypointTominimizetheriskofpersistentleakfromthepuncturesite,takea"Z"trackduringinsertionoftheneedle.(Duringremovaloftheneedle,thesubcutaneoustissuesealsonitself.)14InsertionInthepreviouspuncturesite,inserta17-gaugeneedleattachedtoaover-the-needlecatheterwiththeclampclosed,slowlyadvancetheneedleUponentryintotheperitonealcavity,lossofresistanceisfeltAttachthecathetertoalargesyringe,opentheclamp,aspiratethepleuralfluid15Procedure-withdrawAfterthedesiredamountofasciticfluidhasbeendrained,removethecatheterApplyfirmpressuretostopbleeding,ifpresent.Placeabandageovertheskinpuncturesite.Havepatientremainsupinefor2-4hours16

laboratorytestsGramstain-informationforthedetectionofspontaneousbacterialperitonitis]Cellcount(elevatedcountsmaysuggestinfection)BacterialcultureTotalproteinlevelTriglyceridelevels(elevatedinchylousascites)Bilirubinlevel(maybeelevatedinbowelperforation)GlucoselevelAlbuminlevel,usedinconjunctionwithserumalbuminlevelsobtainedthesameday(usedtocalculateSAAG;Amylaselevel(elevationsuggestspancreaticsource)Lactatedehydrogenase(LDH)levelCytology17MonitoringandFollow-up/

ComplicationsFailedattempttocollectperitonealfluidPersistentleakfromthepuncturesiteWoundinfectionAbdominalwallhematomaSpontaneoushemoperitoneum–Hollowviscusperforation(smallorlargebowel,stomach,bladder)CatheterlacerationandlossinabdominalcavityLacerationofmajorbloodvessel(aorta,mesentericartery,iliacartery)PostparacentesishypotensionHepatorenalsyndrome18PostProcedure

1.Takephysicalexamforvitalsigns2.Tellthepatientstayinbedfor