PARACENTESIS 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: 1. To withdraw fluid for diagnostic examination. 2. To remove ascitic fluid when large accumulation of fluid causes severe symptoms and is resistant to other therapy. 3. To prepare for other procedure (peritoneal dialysis, ascitic fluid reinfusion, surgery, etc.) 4. To identify presence of blood in the abdomen following trauma. INDICATION: Presence of fluid in the abdominal cavity. CONTRAINDICATION: Contraindicated to patients who are: Using blood thinners (anticoagulants) or aspirin, which can increase the chance of bleeding. Having blood, bile, urine, or feces in the fluid sample. Not being able to stay still during the test. Being obese. Having scars inside the belly (adhesions) from any belly surgery in the past. RISKS There is a very small chance that the paracentesis needle may poke the bladder, bowel, or a blood vessel in the belly. If cancer cells are present in the peritoneal fluid, there is a small chance that the cancer cells may be spread in the belly. If a large amount of fluid is removed, there is a small chance that your blood pressure could drop to a low level. This could lead to shock. If you go into shock, IV fluids or medicines, or both, may be given to help return your blood pressure to

normal. There is also a small chance that removing the peritoneal fluid may affect how your kidneys work. If this is a concern, IV fluids may be given during the paracentesis. NURSING ALERT: a. Aspiration of more than 1,500 ml of peritoneal fluid at one time may induce hypovolemic shock. Monitor vital signs every 15 minutes for 1 hour, every 30 mintues for 2 hours, every hour for 4 hours, and every 4 hours for 24 hours to detect delayed reactions. b. Label specimen as they are collected as #1, #2, #3, #4, etc. Note on laboratory slip if the patient is on antibiotic therapy. EQUIPMENT: 1. Sterile paracentesis tray and gloves 2. Drape or cotton blankets 3. Skin preparation tray with antiseptic 4. Procaine hydrochloride 1% 5. Collection bottle (vacuum bottle) 6. Specimen bottles and laboratory forms PREPARATION Before doings paracentesis, ask the patient : Whether he is taking any medicine? If patient is allergic to any medicines, including numbing medicines (anesthetics). If he have had bleeding problems or are taking blood thinners, such as aspirin,nonsteroidal anti-inflammatory drugs (NSAIDs), or warfarin (Coumadin). Patient is or might be pregnant. Other blood tests may be done before a paracentesis to make sure that patient do not have any bleeding or clotting problems. Tell the patient to empty the bladder before the procedure. Ask the patient to sign a consent form. Explain about any concerns patient have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help them understand the importance of this test, fill out the medical test information form from the patient.

PREPARATORY PHASE ACTION 1. Explain procedure to the patient. Rationale: This may reduce the patients fear and anxiety. 2. Record the patients vital signs. Rationale: Provides baseline values for later comparison. 3. Have the patient void before treatment is begun. See that consent form has been signed. Rationale: This will lessen the danger of accidentally piercing the bladder with the needle or trocar. 4. Position the patient in Fowlers position with back, arms and feet supported (sitting on the side of the bed is frequently used position). Rationale: The patient is more comfortable and steady position can be maintained. 5. Drape the patient with sheet exposing abdomen. Rationale: Minimizes exposure of patient and keeps him warm. PERFORMANCE PHASE 1. Assist physician in preparing skin with antiseptic solution. Rationale: This is considered a minor surgical procedure, requiring aseptic precautions. 2. Open sterile tray and package of sterile gloves; provide anesthetic solution. 3. Have collection bottle and tubing available. 4. Assess pulse and respiratory status frequently during procedure; watch for pallor, or syncope. Rationale: Preliminary indications for shock should be watched for. Keep emergency drugs available. 5. Physician administers local anesthesia and introduces No. 20 needle or trocar. 6. Needle or trocar is connected to tubing and vacuum bottle or syringe; fluid is drained from peritoneal cavity. Rationale: Drainage is usually limited to 1-2 liters to relieve acute symptoms and minimize risk of hypovolemia and shock. 7. Apply dressing when needle is withdrawn. Rationale: Elasticised adhesive patch is effective, serving as waterproof adhering dressing. FOLLOW-UP PHASE 1. Assist the patient to be comfortable after treatment. 2. Record amount and kind of fluid removed, number of specimens sent to laboratory, the patients condition through treatment.

3. Check blood pressure and vital signs every half hour for two hours, every hour for 4 hours, and every 4 hours for 24 hours. Rationale: Close observation will detect poor circulatory adjustment and possible development of shock. 4. Usually, a dressing is sufficient; however, if the trocar wound appears large, the physician may close the incision with sutures. 5. Watch for leakage and/or scrotal edema after paracentesis. Rationale: If seen, notify the physician at once. 6. Call doctor immediately if patient have: A fever higher than 100F . Severe belly pain. More redness or tenderness in belly. Blood in urine. Bleeding or a lot of drainage from the site.

CHARTING: a. Document date, time, vital signs, location of puncture site, presence of any sutures. b. Document the amount, color and viscosity and odor of aspirated fluid, measurement of abdominal girth, and patients weight before and after procedure.