Abdominal Paracentesis

Abdominal paracenthesis
Abdominal paracentesis is the removal of fluid from the peritoneal cavity. Like plural
cavity, the peritoneal cavity is also formed by two layers of serous membranes-the visceral layer
surrounding the abdominal organs and a partial layer lining the abdominal cavity. Normally the
peritoneal cavity is only a potential cavity separated by a thin film of serous fluid to lubricate the
surfaces of the peritoneum and prevent infection. In healthy body, the fluid formed in the
peritoneal cavity is absorbed into the lymph circulation through the lymph vessels in the
peritoneum. In disease processes, fluid accumulates with this cavity and cause ascites. Methods
of treatment include restriction of sodium intake, administration of diuretics and occasionally an
abdominal paracentesis.
Purpose Of Abdominal Paracenthesis:

 To relieve pressure on the abdominal and chest organs if a transudates collects as a result
of renal, cardiac or liver diseases.
 To study chemical, bacteriological and cellular composition of the peritoneal fluid for the
diagnosis of diseases.
 To drain an exudates in peritonitis.
 To remove fluid and instill air to create artificial pneumoperitoneum as a treatment for
pulmonary tuberculosis affecting the base of lungs.
Site And Positionning For An Abdominal Paracenthesis:

The primary object of selecting a site is to avoid injury to the urinary bladder and other
abdominal organs. A common site is the midway between the syphysis pubis and the umbilicus
on the midline. An another site may be a point two-third along a line from the imbilicus to the
anterior superior iliac spine.
The patient is positioned in Fowler’s position supported by back rest and pillows near the edge
of the bed.
Complications:
1. Hypovolaemia leading to shock and collapse.
2. Infection(peritonitis)
3. Injury to the blood vessels and other abdominal organs.
4. Renal failure due to reduced systemic circulation
5. Hypoproteinaemia as a result of repeated tapping.
Prepartion Of Articles:
A covered sterile tray containing:
 Sponge holding forceps to clean the skin.
 Syringe (5ml) with needles give local anaesthesia.
 Syringe (20ml) with leur lock for aspiration of fluid.
 Three- way adaptor and tubing.
 Trocar and cannula or aspiration needles.
 B.P handle with blades to make a small skin incision for the introduction of trocar and
cannula.
 Suturing needles (if incision is made)
 Small bowls to take cleaning lotions.
 Dissecting forceps-toothed 1, non toothed 1.
 Specimen bottles.
 Sterile dressing towels or slits.
 Cotton balls, gauze pieces, and cotton pads.
 Gloves, gown and mask.
An nonsterile tray containing:

 Mackintosh and towels.
 Kidney tray and paper bag.
 Spirit, iodine, Tr. Benzoin etc.
 Lignocaine two per cent.
 Apron for the doctor.
 Drainage receptacle to collect the fluid.
 Pint measure to measure the fluid.
 Low stool to raise the drainage receptacle and adjust the height.
Procedure:
The abdominal paracenthesis done under strict aseptic techniques. If it is done for
diagnostic purposes, the fluid withdrawn by a large syringe may be sufficient. If the procedure is
done for relieving pressure symptoms, a trocar and cannula are used. After giving a local
anaesthesia, a small skin incision is made at the site selected and the trocar and cannula are
introduced. After the trocar and the cannula are in position the trocar is removed and the cannula
is attached to the tubing that reaches the drainage receptacle. Occasionally, a soft catheter is
passed through the cannula into the peritoneal cavity for the removal of fluid. After enough fluid
is withdrawn, the cannula is removed and opening is sealed.
General instructions:
 Give adequate explanations to win the confidence and co-operation of the patient.
Patient’s co-operation is very necessary, for the prevention of injury to the adjacent
organs.
 Strict aseptic technique should be followed to prevent introduction of infection into the
peritoneal cavity.
 Ask the patient to void 5 minutes before the procedure to prevent injury to the bladder.
Catheterize the patient if any doubt exists.
 Keep the patient warm and comfortable to prevent chills.
 Be prepared to treat shock. Shock can be prevented by:
 Withdrawing the fluid slowly. Apply clamps on the tubing.
 Withdrawing small quantity of fluid at a time.
 Applying pressure on the abdomen with many tailed bandage and tightening it from
above downwards as the fluid is drained.
 Keeping the patient warm.
 Observing the vital signs continuously during the procedure.
 The drainage receptacle should be raised on the stool. The greater the vertical distance
between the taping needle and the end of the tubing in the drainage receptacle, the
greater is the pull on the fluid in the cavity and more quickly the cavity is drained and the
patient may go into a state of shock.
 Use tapping needle/trocar of smaller gauge possible. This will reduce the puncture wound
as small as possible and there by reduces the chances of fluid leaking from the peritoneal
cavity after the procedure is over.
 The flow of fluid can be controlled by the application of clamps on the tubing.
 The nurse should remain with the patient throughout the procedure to observe the
patient’s general conditions. Changes in colour, pulse, respiration, blood pressure etc.
should be noted and reported to the doctor immediately. These are the indications that
the patient is going into vascular shock and collapse.
 Repeated aspirations of the ascitic fluid will result in hypoproteinaemia. The patient
should be given plasma proteins if he develops such condition.
 The would should be sealed immediately after the procedure to prevent infection and
leakage of peritoneal fluid.
 The specimen collected should be sent to the laboratory without delay. The usual tests
that are carried out are specific gravity, cell count, bacterial count, protein concentrations,
culture, acid fast stain. In most disorders, the fluid is clear and straw coloured. Turbidity
suggests infection. Sanguinous fluid usually signals neoplasm or tuberculosis. The milky
(chylous) fluid is due to lymphoma. A protein concentration of less than 3gm/100ml
suggests liver diseases or systemic disorder; a higher protein content suggests an
exudative cause such as tumor or an infection.
Preparation Of The Patient:

 Explain the procedure to the patient and relatives to obtain their understanding, co-
operation and acceptance of the treatment.
 Get a written consent from the patient or his relatives.
 Prepare the skin as for surgical procedure.
 Record blood pressure, pulse, respiration and weight of the patient on the nurse’s record
before sending the patient to the operation room. This may be used to compare the similar
data obtained during during or after the procedure and to determine the effect of
procedure on the patient.
 Empty the bladder just before the procedure to prevent injury to the distended bladder.
When there is doubt, catheterize the bladder.
 Protect the patient from chills by keeping him warm. Cover the patient with a blanket.
Close the windows and doors to prevent draught. Put off the fan.
 Change the patients garments with hospital dress. Put on loose gowns. The upper
garments may be pinned up to prevent its falling over the abdomen during the procedure.
 Bring the patient to the edge of the bed to prevent over reaching. Place him in a Fowler’s
position supported with the back rest and pillows.
 Maintain privacy with screens and drapes. Drape the patient exposing the abdomen only.
 Protect the bedding with a mackintosh and towel.
 Place a many tailed bandage under the patient to apply over the abdomen during the
procedure in order to maintain the intra-abdominal pressure. This will help to prevent
shock and collapse as the fluid is drained from the abdominal cavity.
 The should remain with the patient throughout the procedure encouraging him to co-
operate and diverting his attention away from the procedure. She should note the colour,
pulse, respiration and BP during the procedure to detect the early signs of collapse and
shock.
After Care Of The Patient:

 As soon as the needle is removed, a sterile dressing and a pressure bandage is applied at
the puncture site to prevent leakage of the fluid.
 The abdominal bandage is tightened to maintain intra-abdominal pressure.
 Check the patient general condition after the procedure. Any change in the colour, pulse,
respiration, BP should be reported immediately. The vital signs are checked half
hourly for two hours, then hourly for 4 hours followed by 4 hourly for 24 hours.
 The specimens collected should be sent to the laboratory with labels and requisition form.
 Examine the dressing at the puncture site frequently for any leakage. Re-inforce the
dressing if leakage is present.
 Serum proteins are estimated to detect hypoproteineamia. If hypoproteeineamia is
present, plasma proteins are administered.
 Record the procedure on the nurse’s record with date and time.
 Clean the articles used. Wash with cold water and then with warm soapy water and rinse
them in clean water. Dry and send for autoclaving.
Conclusion:
Normally the peritoneal cavity is only a potential cavity separated by a thin film of serous
fluid to lubricate the surfaces of the peritoneum and prevent infection. In healthy body, the fluid
formed in the peritoneal cavity is absorbed into the lymph circulation through the lymph vessels
in the peritoneum. In disease processes, fluid accumulates with this cavity and cause ascites.
Methods of treatment include restriction of sodium intake, administration of diuretics and
occasionally an abdominal paracenthsesis.

Abdominal Paracentesis

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Abdominal paracenthesis

Purpose Of Abdominal Paracenthesis:

Site And Positionning For An Abdominal Paracenthesis:

An nonsterile tray containing:

Preparation Of The Patient:

After Care Of The Patient:

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