ABDOMINAL PARACENTESIS

INDICATIONS
Diagnostic tap
New onset ascites - Fluid evaluation to help determine

etiology, to differentiate transudate versus exudate(SAAG), to detect the presence of cancerous cells Diagnose spontaneous bacterial peritonitis Therapeutic tap Respiratory compromise secondary to ascites Abdominal pain or pressure secondary to ascites Instill chemotherapeutic agents

Aspiration of fluid from abdominal cavity

Indications:

1. Nature of fluid by determining SAAG Serum ascites albumin gradient. >1.1 gm/dL = portal HTN related cause eg: cirrhosis Cardiac ascites, portal or splenic vein thrombosis < 1.1 gm/dL = Non portal HTN related causes Eg: TB ascites, Malignancy 2. Refractory to medical treatment 3. Causing cardio pulmonary embarassment

Contraindications
Bleeding diathesisprolonged aPTT or PT
Severe jaundice with impending hepatic coma Multiple abdominal surgeries- loculated effusions Dilated or distended bowel loops Infection at the site. Pregnancy Note: All are relative contraindications

Aetiology
Portal HTN related
Cirrhosis Heart disease Portal or splenic vein

Non-portal HTN related

Abdominal cancer TB peritonitis Chronic renal disease Chronic pancreatic disease Chylous effusion

thrombosis Tricuspid insufficiency

PRE PROCEDURE PRERARATION

Ensure bladder is empty
Ensure patient is not on NSAIDS like aspirin, warfarin Rule out pregnancy Do a coagulation profile

Equipment
Dressing pack
Sterile solutions and swabs Local anesthetic needle Abrams needle/ spinal needle Sterile plastic tubing & sterile bottles

 Premedication

Local anesthesia
Position: supine or semi reclined with back rest Site: midpoint between ASIS and umbilicus Emptying of bladder

 Procedure: Percussion point of maximum dullness Away from epigastric vessels 16G or 18G needle Give-in sensation Connection to plastic infusion and sterile bottles on

floor Abdominal binder Fluid for cytology, microscopy, chemical analysis, culture

Post procedure care

NPO for 4 hrs
TPR, BP monitoring Analgesics Antibiotics if suspicion of infection

Complications
Peritonitis
Perforation of viscus bowel perforation Intraperitoneal bleeding Hepatic coma Persistent leakage in case of malignancy Abdominal wall hematoma Hepatorenal syndrome Hypotension after a large-volume paracentesis

 Write a procedure note which documents the

following: Patient consent Indications for the procedure Relevant labs, e.g INR/PTT, platelet count Procedure technique, sterile prep, anesthetic, amount of fluid obtained, character of fluid, estimated blood loss Any complications Tests ordered

 General labs:

Ammonia, CBC, albumin, amylase, lipase, INR/PTT, platelets.

Labs for ascitic fluid: Protein, albumin, specific gravity, glucose, bilirubin, amylase, lipase, triglyceride, LDH Cell count and differential C&S, Gram stain, AFB, fungal Cytology

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