An ascitic tap, or paracentesis, is a procedure to drain fluid from the abdomen. It is indicated for diagnosing the cause of ascites or excluding spontaneous bacterial peritonitis. The procedure involves using ultrasound guidance to insert a needle into the abdomen and drain fluid for analysis. Precautions are taken due to risks of infection, bleeding, and bowel perforation. Proper consent, aseptic technique, and sample collection are important for diagnostic yield.

1. ASCITIC TAP PROCEDURE
PREPARED BY: GIANNE T.GREGORIO RN

2. LEARNING OBJECTIVES
At the end of the discussion, nurses will be able to:
Define Ascitic Tap
Determine the grade of ascites and its treatment.
Know the indications of ascitic tapping.
Be familiarize with the procedure.

3. OUTLINE
DEFINITION
INDICATIONS
EQUIPEMENT FOR ASCITIC TAP
PRE-PROCEDURE
PROCEDURE
RECOMMENDATIONS
REFERENCES

4. DEFINITION
ASCITES is the abnormal buildup of fluid in the abdomen.
Technically, it is more than 25 ml of fluid in the peritoneal cavity.
Symptoms may include increased abdominal size, increased
weight, abdominal discomfort, and shortness of breath.
Complications can include spontaneous bacterial peritonitis
An ASCITIC TAP is a medical procedure where a needle is used
to drain fluid that is trapped in an internal body cavity, most
commonly the abdomen (belly).

6. INDICATIONS
To aid diagnosis of the cause of ascites or in the diagnosis or
exclusion of Spontaneous bacterial peritonitis.
A diagnostic paracentesis should be performed in all patients with
new onset grade 2 or 3 ascites, and in all patients hospitalized for
worsening of ascites or any complication of cirrhosis.

7. GRADE OF
ASCITES
DEFINITION TREATMENT
1
Mild ascites only detectable
by ultrasound
No treatment
2
Moderate ascites evident by
moderate symmetrical
distension of abdomen
Restriction of sodium and
diuretics
3
Large ascites with marked
abdominal distension
Large volume paracentesis
followed by treatment as for
(2)

8. Equipment required for ASCITIC TAP
(Paracentesis)
• Ultrasound (ideally)
• Dressing trolley &
sharps bin
• Sterile field
• Sterile dressing
pack
• Sterile gloves
• 2% Chlorhexadine
swabs
• Analgesia
• 10ml of 1% or 2%
Lidocaine
• Orange (25G)
needle (x1)
• Green (19G) needle
(x1)
• 10ml Syringe (x1)
• 20ml Syringe (x1)
• with green
(19G) needle
(x1)
• Specimen
containers
• Blood culture
bottles
• Dressing

9. CONTRAINDICATIONS
o Overlying infection
 choose another site
CAUTIONS – but NOT contraindications
o Coagulopathy (INR>2.0)
 Attempt to correct INR to <1.5 if possible.
o Platelets<50
 Thrombocytopenia and coagulopathy is often present in liver disease and though it is a caution, it
not a contraindication to paracentesis or drainage
 The incidence of clinically significant bleeding is low; routine FFP or platelets is not indicated

10. CONTRAINDICATIONS
Pregnancy
Organomegaly
Obstruction/ileus
Distended bladder
Abdominal adhesions

11. Pre-procedure
Consent patient and explain procedure
Consent for infection, bleeding, pain, failure, damage to surrounding structures
(especially bowel perforation – rare), leakage
Lie patient flat and examine clinically to confirm ascites
Ultrasound area for insertion
Define landmarks
Aim for 1/3 to ½ of the way between the anterior superior iliac spine and the
umbilicus avoiding vessels and scars

12. Procedure for Ascitic tap
(PARACENTESIS)
Position the patient supine in the bed with their head resting on a
pillow.
Select an appropriate point on the abdominal wall in the right or left
lower quadrant, lateral to the rectus sheath. If a suitable site cannot be
found with palpation and percussion consider using ultrasound to
mark a spot.
Clean the site and surrounding area with 2% Chlorhexadine and apply
a sterile drape.
Anaesthetise the skin with Lidocaine using the orange needle.

13. Procedure for Ascitic tap
(PARACENTESIS)
Anaesthetise deeper tissues using the green needle, aspirating as you
insert the needle to ensure you are not in a vessel before infiltrating
with lidocaine. Use a maximum of 10mls of Lidocaine.
Take a clean green needle and 20ml syringe and insert through the
skin advancing and aspirating until fluid is withdrawn
Aspirate 20ml
Remove needle and apply sterile dressing

14. RECOMMENDATION
Ensure patient has valid consent.
Obtain accurate assessment and patient history
Always send the most fluid to cytology, especially if malignancy is
suspected. The more fluid sent, the higher the diagnostic yield.
Never dispose of unused fluid, put it in an extra pot and add to the
cytology sample.

15. REFERENCES
 https://www.insideradiology.com.au/ascitic-tap/
 http://www.oxfordmedicaleducation.com/clinical-skills/procedures/paracentesis/