Video Guide: https://www.youtube.com/watch?v=pQSsb9705LE&t=160s
Indications
- Diagnostic: Evaluation of new onset ascites, or known ascites in pts with clinical decompensation, fever, abdominal pain/tenderness, HE, leukocytosis, AKI
- Therapeutic: large volume ascites resistant to diuretics causing pt discomfort
Pre-Procedural considerations
- If therapeutic, determine volume pt typically gets drained so you have enough bottles
- Labs (order before so nurse can print off labels): cell count w/diff, BF culture, BF & serum albumin, total protein; cytology if c/f malignancy; BF/serum Hct if bloody
Procedural considerations
- Ultrasound Probe: curvilinear, to identify safe pocket (~2 cm)
- Kit: 6 Fr Safe-T-Centesis Kit
- If only diagnostic, use 18G needle with 20-50cc syringe rather than kit
- If high bleeding risk, use long 18 g. needle & attach to syringe instead of 6 Fr. Catheter
- Avoid surgical scars out of concern for nearby adhesions and superficial veins
- Z-track method: may reduce post-paracentesis ascitic fluid leakage. Once into subcutaneous tissue, move superior/inferior to allow tissue overlap.
- Attempt as lateral as possible to avoid inferior epigastric vessels
- Roll patient to left or right side to promote pooling of fluid for easier/safer access
- Inoculate culture bottles at bedside rather than sending fluid samples to lab for inoculation to increase yield 50% 80% (VA does not allow bedside inoculation.)
- If hernia present, have patient reduce it while draining fluid to prevent incarceration
Post-procedural considerations
- Albumin for large volume (>5L): give 8 grams per liter removed
- Ascitic leak: roll pt on opposite side; place 1 figure-of-eight stitch with 4.0 vicryl
- Bleeding complication – Hold pressure with quick-clot and gauze for >5-10 if persistent bleeding at site; if profuse bleeding or concern for organ injury, STAT page EGS