This document provides information on abdominal paracentesis including:
1. It defines abdominal paracentesis as a procedure where a needle or catheter is inserted into the peritoneal cavity to obtain ascitic fluid for diagnostic or therapeutic purposes.
2. The indications, contraindications, technique, complications, and post-procedure follow up of abdominal paracentesis are described in detail over multiple pages.
3. The preparation, positioning, equipment, steps of the technique, and potential complications of the procedure are outlined systematically for medical practitioners.
COLONOSCOPY- A PICTORIAL OVERVIEW
• Dear viewers,
• Greetings from “Surgical Educator”
• This week I have uploaded a video on Colonoscopy- the Lower GI Endoscopy.
• In this episode, I showed only the colonoscopic features of common pathologies in colon and rectum.
• I restricted my talk to the essential minimum that an undergraduate medical student must know about the Colonoscopy.
• I discussed about the diagnostic and therapeutic procedures you can do with the Colonoscopy.
• I hope it would be interesting and very useful to all my viewers.
• You can access this video in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
COLONOSCOPY- A PICTORIAL OVERVIEW
• Dear viewers,
• Greetings from “Surgical Educator”
• This week I have uploaded a video on Colonoscopy- the Lower GI Endoscopy.
• In this episode, I showed only the colonoscopic features of common pathologies in colon and rectum.
• I restricted my talk to the essential minimum that an undergraduate medical student must know about the Colonoscopy.
• I discussed about the diagnostic and therapeutic procedures you can do with the Colonoscopy.
• I hope it would be interesting and very useful to all my viewers.
• You can access this video in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
It is a procedure where small piece of liver tissue is removed and examined to Confirm clinical diagnosis, and assess the severity, and progression treatment response of the disease.
Colonoscopy is a procedure used to see
inside the colon and rectum. Colonoscopy can detect inflamed tissue, ulcers,
and abnormal growths. The procedure is used to look for early signs of
colorectal cancer and can help doctors diagnose unexplained changes in bowel
habits, abdominal pain, bleeding from the anus, and weight loss.
NIDDK
Thoracentesis (thor-a-sen-tee-sis) is a procedure that is done to remove a sample of fluid from around the lung.
The lung is covered with a tissue called the pleura. The inside of the chest is also lined with pleura.
The space between these two areas is called the pleural space.
This space normally contains just a thin layer of fluid, however, some conditions such as pneumonia, some types of cancer, or congestive heart failure may cause excessive fluid to develop (pleural effusion).
Thoracentesis, also known as pleural fluid analysis, is a procedure in which a needle is inserted through the back of the chest wall into the pleural space (a space that exists between the two lungs and the anterior chest wall) to remove fluid or air.
Pleural fluid analysis is the microscopic and chemical lab analysis of the fluid obtained during thoracentesis.
IndDiagnostic: determination of pleural effusion etiology (e.g. transudative versus exudative) usually requires the removal of 50 to 100mL of pleural fluid for laboratory studies. Most new effusions require diagnostic thoracentesis, an exception being a new effusion with a clear clinical diagnosis (e.g. CHF) with no evidence for superimposed pleural space infection
Therapeutic: reduce dyspnea and respiratory compromise in patients with large pleural effusions. This is typically achieved by removing a much larger volume of fluid compared to the diagnostic thoracentesis
ications
It is a procedure where small piece of liver tissue is removed and examined to Confirm clinical diagnosis, and assess the severity, and progression treatment response of the disease.
Colonoscopy is a procedure used to see
inside the colon and rectum. Colonoscopy can detect inflamed tissue, ulcers,
and abnormal growths. The procedure is used to look for early signs of
colorectal cancer and can help doctors diagnose unexplained changes in bowel
habits, abdominal pain, bleeding from the anus, and weight loss.
NIDDK
Thoracentesis (thor-a-sen-tee-sis) is a procedure that is done to remove a sample of fluid from around the lung.
The lung is covered with a tissue called the pleura. The inside of the chest is also lined with pleura.
The space between these two areas is called the pleural space.
This space normally contains just a thin layer of fluid, however, some conditions such as pneumonia, some types of cancer, or congestive heart failure may cause excessive fluid to develop (pleural effusion).
Thoracentesis, also known as pleural fluid analysis, is a procedure in which a needle is inserted through the back of the chest wall into the pleural space (a space that exists between the two lungs and the anterior chest wall) to remove fluid or air.
Pleural fluid analysis is the microscopic and chemical lab analysis of the fluid obtained during thoracentesis.
IndDiagnostic: determination of pleural effusion etiology (e.g. transudative versus exudative) usually requires the removal of 50 to 100mL of pleural fluid for laboratory studies. Most new effusions require diagnostic thoracentesis, an exception being a new effusion with a clear clinical diagnosis (e.g. CHF) with no evidence for superimposed pleural space infection
Therapeutic: reduce dyspnea and respiratory compromise in patients with large pleural effusions. This is typically achieved by removing a much larger volume of fluid compared to the diagnostic thoracentesis
ications
An IVU (Intravenous Urography) is an x-ray of your urinary tract (consisting of kidneys, ureters and bladder) following an injection of a clear dye called contrast into a vein in your arm.
The pictures produced are called intravenous urograms (IVU) or intravenous pyelograms (IVP).
A series of x-rays are taken of the abdomen at various time intervals. This usually takes up to an hour, but occasionally it may be necessary to take additional delayed images, which may continue for several hours.
Routine IVP[edit]
This procedure is most common for patients who have unexplained microscopic or macroscopic hematuria. It is used to ascertain the presence of a tumour or similar anatomy-altering disorders. The sequence of images is roughly as follows:
plain or Control KUB image;
immediate X-ray of just the renal area;
5 minute X-ray of just the renal area.
15 minute X-ray of just the renal area.
At this point, compression may or may not be applied (this is contraindicated in cases of obstruction).
In pyelography, compression involves pressing on the lower abdominal area, which results in distension of the upper urinary tract.[1]
If compression is applied: a 10 minutes post-injection X-ray of the renal area is taken, followed by a KUB on release of the compression.
If compression is not given: a standard KUB is taken to show the ureters emptying. This may sometimes be done with the patient lying in a prone position.
A post-micturition X-ray is taken afterwards. This is usually a coned bladder view.
Image Assessment[edit]
Objectives :
-List the indications and contraindications for urinary catheterization.
- Indicate the appropriate catheter type/size.
- Discuss the risks associated with catheterizations.
-Describe the equipment for female/male/pediatric urinary catheterization.
- Discuss a safe method of performing urinary catheterizations .
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
4. cont
• Paracentesisis a procedure in which a needle or catheter
is inserted into the peritoneal cavity to obtain ascitic fluid
for diagnostic or therapeutic purposes.
• paracentesis can be done for
-diagnostic or
-therapeutic purpose
• Diagnostic paracentesis refers to the removal of a
small quantity of fluid for testing.
5. Cont
• Therapeutic paracentesis refers to the
removal of 5 liters or more of fluid
To reduce and relives
- intra-abdominal pressure
-dyspnea,
-abdominal pain, and
-early satiety.
6. INDICATION
1-Diagnostic tap
is used for the following:
a) New-onset ascites: Fluid evaluation helps to
determine etiology,
differentiate transudate versus exudate,
detect the presence of cancerous cells,
or
address other considerations
b) Suspected spontaneous or secondary bacterial
peritonitis
7. 2-Therapeutic tap
is used for the following:
a) Respiratory compromise secondary to ascites
b) Abdominal pain or pressure secondary to ascites
(including abdominal compartment syndrome)
9. Absolute Contraindication
1. Patients with clinically apparent disseminated
intravascular coagulation and oozing from needle
sticks probably should not undergo paracentesis. This
occurs in <1/1000 patients with ascites in our
experience.
1. Primary fibrinolysis (which should be suspected in
patients with large, three-dimensional bruises) is
probably another contraindication. Paracentesis can
be performed once the bleeding risk is reduced with
treatment .
10. 3. Paracentesis should not be performed in patients with
a massive ileus with bowel distension unless the
procedure is image-guided to ensure that the bowel
is not entered.
4. The location of the paracentesis should be modified
in patients with surgical scars so that the needle is
inserted several centimeters away from the scar.
11.
Surgical scars are associated with tethering of
the bowel to the abdominal wall, increasing the risk of
bowel perforation. Bowel perforation by the
paracentesis needle occurs in approximately 6/1000
taps. Fortunately, it is generally well tolerated
5. an acute abdomen that requires surgery is an absolute
contraindication..
12. Relative Contraindication
1) Severe thrombocytopenia
platelet count < 20 X 103/μL and
coagulopathy (international normalized ratio [INR] >2.0)
2)
3)
4)
5)
6)
Pregnancy
Distended urinary bladder
Abdominal wall cellulitis
Distended bowel
Intra-abdominal adhesions
13. • Patients with an INR greater than 2.0 should receive fresh
frozen plasma (FFP) prior to the procedure.
• One strategy is to infuse one unit of fresh frozen plasma
before the procedure and then perform the procedure while
the second unit is infusing.
• Patients with platelet count of less than 20 X 103/μL should
receive an infusion of platelets prior to performing the
procedure.
14. • In patients without clinical evidence of active bleeding, routine
laboratory tests such as prothrombin time (PT), activated
partial thromboplastin time (aPTT), and platelet counts may
not be needed prior to the procedure.Inthese patients,
pretreatment with FFP, platelets, or both before the
paracentesis is also probably not needed
16. PATIENT POSITION
Usually performed with patient supine position
Rarely patient can be positioned lateral decubitus
This is used only 1-there is small amount of fluid and
2-The suspected diagnosis is crucial
to the patient outcome(eg,Tb peritonitis)
The lateral decubitus position is advantageous because airfilled loops of bowel tend to float in a distended abdominal
cavity.
17. Needle Entry Site
• The two recommended areas of abdominal wall entry for
paracentesis are as follows.
- 2 cm below the umbilicus in the midline (through the linea
alba)
-5 cm superior and medial to the anterior superior iliac
spines on either side(in update 3cm)
18. Cont’d
• The midline approach is now seldom used since most
paracenteses (about 90 percent) are therapeutic and
many patients are obese.
• In the past, the midline, cephalad from the umbilicus,
was frequently used as the site of needle entry because
of its relative avascularity. However, the recanalized
umbilical vein may be present caudal to the umbilicus in
the midline, an area that should be avoided.
19. Needle Entry Site To Avoid
The inferior epigastric artery traces from a point just lateral to
the pubic tubercle (which is 2 to 3 cm lateral to the symphysis
pubis), cephalad within the rectus sheath.
This artery can be 3 mm in diameter and can bleed massively if
punctured with a large- caliber needle. Thus, this site should be
specifically avoided.
areas near surgical scars should be avoided.
Visible veins should also be avoided.
20. Equipment
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Antiseptic swab sticks
Fenestrated drape
Lidocaine 1%, 5-mL ampule
Syringe, 10 mL
Injection needles, 22 gauge (ga), 2
Injection needle, 25 ga
Scalpel, no. 11 blade
Catheter, 8F, over 18 ga !
7 1/2" needle with 3-way stopcock,
self-sealing valve,
and a 5-mL Luer-Lock syringe
Syringe, 60 mL
Introducer needle, 20 ga
Tubing set with roller clamp
Drainage bag or vacuum container
Specimen vials or collection bottles, 3
Gauze, 4 ! 4 inch
Adhesive dressing
21. Technique
① Explain the procedure, benefits, risks, complications, and
alternative options to the patient or the patient's representative.
② Obtain signed informed consent.
③ Empty the patient's bladder, either voluntarily or with a Foley
catheter.
④ Position the patient and prepare the skin around the entry site with
an antiseptic solution
22. Cont’d
⑤ Apply a sterile fenestrated drape to create a sterile field
⑥ Use the 5-mL syringe and the 25-ga needle to raise a small
lidocaine skin wheal around the skin entry site
23. Cont’d
⑦ Switch to the longer 20-ga needle and administer 4-5 mL of
lidocaine along the catheter insertion tract (see image below).
Make sure to anesthetize all the way down to the peritoneum. The
authors recommend alternating injection and intermittent aspiration
down the tract until ascitic fluid is noticed in the syringe. Note the
depth at which the peritoneum is entered. In obese patients,
reaching the peritoneum may involve passing through a significant
amount of adipose tissue.
24. Cont’d
⑧
Use the No. 11 scalpel blade to make a small nick in the skin to
allow an easier catheter passage
⑧
Insert the needle directly perpendicular to the selected skin entry
point. Slow insertion in increments of 5 mm is preferred to
minimize the risk of inadvertent vascular entry or puncture of the
small bowel.
25. Cont’d
⑩
Continuously apply negative pressure to the syringe as the needle
is advanced. Upon entry to the peritoneal cavity, loss of resistance
is felt and ascitic fluid can be seen filling the syringe .At this point,
advance the device 2-5 mm into the peritoneal cavity to prevent
misplacement during catheter advancement. In general, avoid
advancing the needle deeper than the safety mark that is present
on most commercially available catheters or deeper than 1 cm
beyond the depth at which ascitic fluid was noticed in the lidocaine
syringe.
26. Cont’d
11 Use one hand to firmly anchor the needle and syringe securely in
place to prevent the needle from entering further into the peritoneal
cavity
12
Use the other hand to hold the stopcock and catheter and advance
the catheter over the needle and into the peritoneal cavity all the way
to the skin (see image and video below). If any resistance is noticed,
the catheter was probably misplaced into the subcutaneous tissue. If
this is the case, withdraw the device completely and reattempt
insertion. When withdrawing the device, always remove the needle
and catheter together as a unit in order to prevent the bevel from
cutting the catheter
27. Cont’d
13 While holding the stopcock, pull the needle out. The self-sealing valve
prevents fluid leak.
Attach the 60-mL syringe to the 3-way stopcock and aspirate to
obtain ascitic fluid and distribute it to the specimen vials (see images and
video below). Use the 3-way valve, as needed, to control fluid flow and
prevent leakage when no syringe or tubing is attached.
28. Cont’d
14 Connect one end of the fluid collection tubing to the stopcock and
the other end to a vacuum bottle or a drainage bag.
29. Cont’d
• The catheter can become occluded by a loop of bowel or omentum.
If the flow stops, kink or clasp the tubing to avert loss of suction,
then break the seal and manipulate the catheter slightly, then
reconnect and see if flow resumes. Rotating the catheter about the
long axis can sometimes reinstitute flow in models with side ports.
• Remove the catheter after the desired amount of ascitic fluid has
been drained (see image below). Apply firm pressure to stop
bleeding, if present. Place a bandage over the skin puncture site.
30. Complication
•
•
•
•
•
•
•
•
•
•
•
Failed attempt to collect peritoneal fluid
Persistent leak from the puncture site
Wound infection
Abdominal wall hematoma
Spontaneous hemoperitoneum: This rare complication is due to
mesenteric variceal bleeding after removal of a large amount of ascitic
fluid (>4 L).
Hollow viscous perforation (small or large bowel, stomach, bladder)
Catheter laceration and loss in abdominal cavity
Laceration of major blood vessel (aorta, mesenteric artery, iliac artery)
Postparacentesis hypotension
Dilutional hyponatremia
Hepatorenal syndrome