Paracentesis for nursing student

1. ANCY T F
MSC NURSING
GOVT COLLEGE OF NURSING
THIRUVANANTHAPURAM

2. Itoduction
Paracentesis is a procedure frequently performed in the intensive
care unit for diagnostic and therapeutic purposes. Paracentesis was
once considered a routine form of treatment for ascites but is
now performed primarily for diagnostic examination of ascitic
fluid, for treatment of massive ascites that is resistant to
nutritional and diuretic.

3. DEFINITION
Paracentesis is the removal of fluid (ascites) from the peritoneal
cavity through a small surgical incision or puncture made through
the abdominal wall under sterile conditions.

4. PURPOSES
To relieve pressure on the abdominal and chest organs due to ascites
To study chemical, bacteriological and cellular composition of
peritoneal fluid for diagnosis of disease.
To drain exudate in peritonitis.
To prepare for procedures like peritoneal dialysis.

5. 1 To relieve pressure on the abdominal and chest organs due to ascites
acitis can make difficutty in breathing,eating, moving
It iead to hard to breath
2 To study chemical, bacteriological and cellular composition of peritoneal fluid for
diagnosis of disease.
serum-albumin
3. To drain exudate in peritonitis
Peritoneal exudate fluid is very small in quantity and contains
some neutrophilic leukocytes, macrophages and lymphocytes.
The peritoneal exudate is therefore usually collected to obtain
the leukocytes, especially free macrophages.

6. 4.To prepare for procedures like peritoneal dialysis.
In alcoholic cirrhotic patients with ascites, gastric emptying of solids is
delayed, independently of the volume of ascites.

7. INDICATION

8. Diagnostic paracentesis
 patients with suspected spontaneous bacterial peritonitis
(SBP)
 ascites of unknown cause.
 Other less common diagnostic studies include:
triglycerides (chylous ascites), amylase (pancreatic ascites)
mycobacterial culture (tuberculous ascites)
bilirubin (bile leak).

9. Therapeutic Paracentesis
 patients with significant shortness of breath or abdominal
discomfort
 decompensated cirrhosis
 abdominal pain from distention
 percutaneous decompression of resuscitation-induced
abdominal compartment syndrome.

10. NURSING
IMPLICATION

11. Pre procedure
1. Check For signed consent Form.
2. Prepare the patient by providing the necessary information and
Instructions and by offering reassurance.
3. Instruct the patient to void.
4. Gather appropriate sterile equipment.
5. Place the patient in upright position on the edge of the bed or in a chair
with feet supported on a stool.
6. Place the sphygmomanometer cuff around patient’s arm.

12. Procedure
1. The physician, using aseptic technique, inserts the trocar through a
puncture below the umbilicus. The trocar or needle is connected to a
drainage tube, the end of which is inserted into a collecting receptacle.
2. Help the patient maintain position throughout the procedure.
3. Measure and record blood pressure at frequent intervals throughout the
procedure.
4. Monitor the patient closely for signs of vascular collapse: pallor,
increased pulse rate, or decreased blood pressure.

13. Post procedure.
1.Return the patient to bed or to a comfortable sitting position.
2 Measure, describe. and record the fluid collected.
3, Label samples of fluid and send to laboratory.
4. Monitor vital signs every 15 min for1 h, every 30 min for 2
h, every hour for 2 h, and then every 4 hr.
5.Measure the patient’s temperature.

14. 6. Assess For hypovolemia, electrolyte shifts, changes in mental
status, and encephalopathy.
7. When taking vital signs, check puncture site for leakage or
bleeding.
8. Provide patient teaching regarding need to monitor for
bleeding or excessive drainage from puncture site, importance of
avoiding heavy lifting or straining, the need to change position
slowly, and frequency of monitoring for Fever.

15. COMPLICATIONS

16. • bleeding and persistent ascitic leak.
• intestinal or urinary bladder perforation, with associated
peritonitis and infection.
• transient hypotension and paracentesis-induced circulatory
dysfunction (PICD)
• a drop in blood pressure, which only occurs if a significant
volume of fluid is removed
• an accidental puncture of a blood vessel, the bowel, or the
bladder
• an acute kidney injury