Paracentesis is a procedure to remove fluid from the peritoneal cavity for diagnostic and therapeutic purposes. Large amounts of ascites fluid can cause respiratory compromise by exerting pressure on the diaphragm and abdominal organs. Paracentesis relieves this pressure and improves breathing. Key steps include ultrasound assessment, local anesthesia, inserting a needle into the abdomen, draining fluid, and analyzing laboratory samples of the fluid. Complications may include infection, bleeding, or organ damage.

2.  The accumulation of large amount of fluid within
the peritoneal cavity exerts pressure on the
diaphragm and abdominal organs and
vasculature, leading to respiratory compromise
and increased work of breathing. Paracentesis
relieves intra abdominal and diaphragmatic
pressures, diminishing the work of breathing.

3.  “ Paracentesis is a procedure in which
fluid is removed from the peritoneal cavity for
diagnostic and therapeutic purposes.”

4. 1.To obtain fluid samples from the peritoneal
space for diagnostic examination.
2. Evacuate fluid from the peritoneal space.
3. Alleviate respiratory compromise related to
pressure on the diaphragm caused by ascetic
fluid.

6. New onset ascites or ascites of
unknown origin.
Patient with a known ascites who has
fever, abdominal pain, hypotension or
encephalopathy.
Symptomatic treatment of large
ascites.

7. × Uncooperative patients
× Uncorrected bleeding diathesis
× Acute abdomen that requires surgery
× Intra-abdominal adhesions
× Distended bowel
× Abdominal wall cellulitis at the site of puncture
× Pregnancy

8. 

9.  Sterile gloves, gown and mask
 Povidone iodine solution
 Sterile drape
 Lidocaine 2%
 5cc syringe and needle
 25 gauge needle
 10cc syringe-2

10.  50cc syringe-2
 Trocar with stylet
 Sterile tubes for specimen
 Surgical blade
 Three way stop cock
 Sterile 1l collection bottle
 Gauze and tape

11. 4 STEPS OF THE
PARACENTESIS
PROCEDURE..

12. 1. Ultrasound scan before
the procedure
2. Patient preparation
3. Procedure
4. Laboratory results

13. What is the distance from the skin to
the fluid?
Usually 1 cm. It gives an idea how
deep you have to go with the needle
before getting fluid in the syringe.

14. Explain the rba (risks, benefits,
alternatives)
 Informed written consent urinate before
the procedure or use a folley’s to empty
the bladder.
Position the patient in the bed with the
head elevated at 45-60 degrees to allow
fluid to accumulate in lower abdomen.

15.  Position the patient in the bed with the head
elevated at 45-60 degrees
To allow fluid to
Accumulate
in lower abdomen.

17.  2 cms below the umbilicus in the midline
(through the linea alba)
 5 cms superior and medial to the anterior
superior iliac spines on either side.

18.  Position the patient and prepare the skin
around the entry site with an antiseptic
solution .

19.  DRAPING.

20.  4-5 mL of lidocaine along the catheter
insertion tract,anesthetise
all the way down to the peritoneum.

21. Use the No. 11 scalpel blade to
make a small nick in the skin to
allow an easier catheter
passage.

22.  Insert the needle directly
perpendicular to the
selected skin entry point.
Continuously apply negative
pressure to the syringe as
the needle is advanced.
 Upon entry to the peritoneal
cavity, loss of resistance is felt
and ascitis fluid can be seen filling
the syringe.

23.  Use one hand to firmly
anchor the needle and
syringe securely in place to
prevent the needle from entering
further the peritoneal cavity
Stabilization of needle
and syringe

24. While holding the stopcock, pull
the needle out.
Attach the 50-ml syringe to the
3-way stopcock and aspirate to
obtain ascitis fluid.

26. Connect one end of the fluid
collection tubing to the stopcock
and the other end to a vacuum
bottle or a drainage bag .

28. Consent
Indications and contraindications
for procedure
 Procedure, including prep,
anesthetic, needle size, amount of
fluid drawn off, character of fluid
 Any complications or “none”
Who was notified of any
complication (family, attending MD)

29. NURSING
CONSIDERATIONS

30.  Fluid specimen for laboratory analysis.
 Record amount ,characteristics of fluid ,
number of specimens sent to laboratory.
 Patient’s condition during treatment

31.  Check vital signs every half hour for two
hours, every hour for four hours and every
four hour for 24 hours.
 Watch for leakage or scrotal edema after
paracentesis.
 Observe the site for bleeding
 Replace the articles

33. Gram stain (bacterial peritonitis.)
Cell count (elevated counts may
suggest infection)
Bacterial culture
Total protein level
Triglyceride levels (elevated in
chylous ascites)
Bilirubin level (may be elevated in
bowel perforation)
Glucose level
Amylase level (elevation suggests
pancreatic source)

35.  Perforation of bowel or bladder.
 Local or systemic infection.
 Hypovolemia, hypotension.
 Bleeding from paracentesis site.
 Ascetic leak from paracentesis site.