ParacentesisParacentesisParacentesisParacentesis

- Definition -

Paracentesis

is a procedure to take out fluid that has collected in the belly (peritoneal fluid). This fluid buildup is called ascites. Ascites may be caused by infection, inflammation, an injury, or other conditions, such as cirrhosis or cancer. The fluid is taken out using a long, thin needle put through the belly. The fluid is sent to a lab and studied to find the cause of the fluid buildup. Paracentesis also may be done to take the fluid out to relieve belly pressure or pain in people with cancer or cirrhosis.

- Objectives -

Paracentesis is use to:

• Extract fluid accumulations in peritoneum.• Relieve intra-abdominal tension, which

can impair the client’s respiratory status.• Obtain fluid for culture

Indications

New onset ascites of unknown originPatient with a known ascites who has fever, abdominal pain, hypotension or encephalopathySymptomatic treatment of large ascites

Contraindications

Uncooperative patientUncorrected bleeding diathesisAcute abdomen that requires surgeryIntra-abdominal adhesionsDistended bowelAbdominal wall cellulitis at the site of puncturePregnancy

Complications

Persistent leak from the puncture siteAbdominal wall hematomaPerforation of bowelIntroduction of infectionHypotension after a large-volume paracentesisDilutional hyponatremiaHepatorenal syndromeMajor blood vessel lacerationCatheter fragment left in the abdominal wall or cavity

Equipments• Sterile Paracentesis tray and gloves• Local Anesthethic• Drape or cotton blankets• Collection bottle (vacuum bottle)• Skin preparation tray with antiseptic• Specimen bottles and laboratory forms

ProcedureNursing Actions

Preparatory Phase• Explain Procedure to the patient (This may reduce the

patient’s fear and anxiety)• Record the patient’s vital signs (Provides baseline values for

later comparison)• Have the patient void before the treatment is begun. Make

sure that consent form has been signed (This will lessen the danger of accidentally piercing the bladder with the needle or trocar)

• Position the patient in Fowler’s position with his back, arms and feet supported (The patient is more comfortable, and a steady position can be maintained)

• Drape the patient with sheet exposing abdomen (Minimizes exposure of patient and keeps patient warm)

Performance Phase• Assist in preparing skin with antiseptic solution (This is considered a

minor surgical procedure that requires a septic precautions)• Open sterile tray and package of sterile gloves; provide an anesthetic

solution.• Have collection bottle and tubing available.• Assess pulse and respiratory status frequently during procedure;

watch for pallor, cyanosis, or syncope (faintness). (Indicates shock. Keep emergency drugs available)

• Physicians administers local anesthesia and introduces needle or trocar.

• Needle or trocar is connected to tubing and vacuum bottle or syringe; fluid is slowly drained from peritoneal cavity ( Drainage is usually limited to 1 – 2L to relieve acute symptoms and minimize risk of hypovolemia and shock)

• Apply dressing when needle is withdrawn. (Elasticized adhesive patch is effective, serving as waterproof adhering dressing)

Follow-up Phase• Assist the patient to a comfortable position after

treatment.• Record amount and characteristics of fluid removed;

number of specimens sent to a laboratory, the patient’s condition during treatment (Documentation is important for continuity of care)

• Check blood pressure and Vital signs every ½ hours for two hours every hour for four hours, and every four hours for 24 hours ( Close observation will detect poor circulatory adjustment and possible development of shock)

• Usually, a dressing is sufficient; however, if the trocar wound appears large, the physician may close the incision with suteres. (To prevent blood loss and aid healing)

• Watch for leakage or scrotal edema after paracentesis (If seen, report at once)

- VIDEO -

- Nursing Interventions -

Preoperative Care

The procedure usually takes place at the bedside. Obtain written permission before the procedure begins and explain the purpose and steps involved. Ask the client to void immediately before the procedure to decrease the risk of bladder puncture. Have the client sit upright on the edge of the bed with the feet resting on a stool and the back well supported.

Postoperative Care

The major complication of paracentesis is hypovolemia and shock secondary to fluid drainage from peritoneum, the resulting fluid shift from intravascular to interstitial space, and the sudden change in the intra abdominal pressure on the vessels.This fluid shift is exacerbated by hypoalbuminemia.

Assess vital signs and peripheral circulation every few minutes during abd immediately after paracentesis. Observe for hypovolemic shock: pallor, tachycardia, decreased blood pressure, olyguria and dyspnea.Hepatic Enephalopathy, caused by reduced tissue perfusion, is another complication resulting from drainage of ascitic fluid. Because ascitic fluid contains a high concentration of protein the physician may prescribe albumin infusions for 24 hours after paracentesis to compensate for protein loss. Potassium depletion may also occur after multiple paracentesis procedures. Infection, peritonitis, and bleeding related to vessel trauma occasionally complicate paracentesis.

Carefully assess for abdominal pain after paracentesis. In addition, monitor the puncture site for persistent leakage of ascitic drainage.

Reported By:

Carle Servidad4BSN5/Group13