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Assisting inAbdominal Paracentesis
By: Maria Decerie A. Penollera
BSNIV Neuman
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Definition
It is a sterile invasive procedureperformed by the physician toobtain peritoneal fluid from theperitoneal cavity through a small
opening or puncture madethrough the abdominal wall.
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Also known as Abdominal Tap
A strict sterile technique is to be followed
It is an outpatient procedure
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The Abdominal Wall
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4 Quadrants
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9 Regions of the Abdomen
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Purpose
Diagnostic
peritoneal fluid is analyzed to determine
the presence of bacteria, blood, glucose,and protein.
for cytologic analysis.
Palliative measures to provide temporary relief of respiratory
and abdominal discomfort caused by ascites
or reduce intraabdominal pressure
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Indication
New onset ascites or ascites of unknownorigin
Patients with ascites of known etiology whomay have a decompensation clinical state as
indicated by fever, painful abdominaldistention, peritoneal irritation, hypotension,encephalopathy or sepsis
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Indication Cont
Suspected malignant ascites
Peritoneal dialysis patients with fever,abdominal pain or other signs of sepsis(usually the paracentesis fluid may be
removed directly from the patients dialysiscatheter)
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Contraindication
Uncorrected bleeding diathesis
Previous abdominal surgeries withsuspected adhesions
Severe bowel distention/obstruction
Abdominal wall cellulitis at the proposedsite of puncture
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Contraindication Cont
Pregnancy
Organomegaly
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Assessment
Note for allergies of any medication
Note for bleeding problems
Patient is taking any blood thinningmedications
Check informed consent
Assess the knowledge of the patient
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Materials
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Materials cont
Specimen container
Big syringe (to aspirate)
Tubing
Trocar
Cannula
Aspirating set
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Materials cont
Antiseptics
Sponges Fenestrated drape
Small scalpel
Gloves and mask
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Materials cont
receptacle for fluid
1% or 2% lidocaine with epinephrinefor local anesthesia
If available, a bedside ultrasoundmachine is an asset
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1. Check doctors order and consent foroperation.
2. Prepare all needed materials.3. Explain the procedure to the client.
4. Do handwashing.
5. Premedicate the patient if indicated.
6. Have the patient void before beginning
the procedure.
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7. Position the patient sitting on theedge of edge of the bed.
8. Drape the patients back and legs.9. Set up the equipment on a
convenient overbed table, arranging
the sterile field.
10.Make sure that a straight chair isavailable.
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11.Observe the patient particularly forpallor, dizziness, faintness,
diaphoresis, and rapid pulse andrespirations.
12.Reassure the patient to relieve
anxiety throughout the procedure.13.Assist with the procedure, providing
equipment as needed.
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Site:
Right Lower
quadrant
Left Lower
quadrant
Midway between the umbilicus and the symphysis pubis
on the midline or 2 inch below the umbilicus
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14.Assist patient in assuming acomfortable position and allow a restperiod after the procedure.
15.Label and properly care for anyspecimen obtained.
16.Record amount and kind of fluidremoved, number of specimens sentto laboratory, patients condition
throughout treatment.
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17.Check / monitor BP, pulse rate andrespiratory rate every hour for 2
hours; every hour for 4 hours; andevery 4 hours for 24 hours.
18.Report to physician any untoward
signs or symptoms noted.19.Do after care of equipment used
20.Wash hands / do hanwashing.
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Documentation
Date and time performed
Primary care providers name
Abdominal girth before and after The color, clarity and amount of drained
fluid
Normal ascitic fluid: serous, clear, and light yellowin color
Nurses assessment and intervention.
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Complications
Hyponatremia
Bleeding
Intraabdominal injury
Inferior epigastric arterypuncture
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FIN!!
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