Paracentesis

- 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 origin
Patient with a known ascites who has fever, abdominal pain,
hypotension or encephalopathy
Symptomatic treatment of large ascites

Contraindications
Uncooperative patient
Uncorrected bleeding diathesis
Acute abdomen that requires surgery
Intra-abdominal adhesions
Distended bowel
Abdominal wall cellulitis at the site of puncture
Pregnancy
Complications
Persistent leak from the puncture site
Abdominal wall hematoma
Perforation of bowel
Introduction of infection
Hypotension after a large-volume paracentesis
Dilutional hyponatremia
Hepatorenal syndrome
Major blood vessel laceration
Catheter 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
Procedure
Nursing 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 Servidad
4BSN5/Group13