Abdominal paracentesis in pediatrics is a procedure used to remove fluid (ascites) from the peritoneal cavity for diagnostic or therapeutic purposes. It requires careful technique and child-specific considerations.
Indications
- To determine the cause of ascites
- To determine if intra-abdominal bleeding is present or if a viscous has ruptured
- For therapeutic removal of fluid when distension is pronounced or there is associated respiratory distress
Contraindications
- Uncooperative patient
- Uncorrected bleeding diathesis
- Acute abdomen that requires surgery
- Intra-abdominal adhesions
- Distended bowel
Equipment Needed
A sterile tray containing:
- Sponge holder
- Syringe (5 mL) with needles
- 20-mL syringe with Luer lock
- Three-way adopter and tubing
- Aspiration needles
- Antiseptic solution
- Gloves, gown, and mask
- Local anesthetic
- Drape or cotton blankets
- Collection bottle/container
- Specimen bottles and laboratory forms
- Sterile dressing towels
- Cotton balls, gauze pieces
- Dressing pads
Preparation
- Explain the procedure to the parents and the child as appropriate.
- Obtain a written consent from the parents.
- It is very helpful to get an ultrasound scan of the ascites before the procedure.
The radiologist will mark the spot for paracentesis. - Record the child’s vital signs.
- Have the child void before procedure is begun.
- Position the child in Fowler’s position with back, arms, and feet supported.
- Drape the child with sheet exposing abdomen.
Positioning
- Patients with less amount of fluid: Lateral decubitus position.
- Child with large quantity of ascites: Supine position with head of bed elevated to 30-45°
Site Selection
- Approximately 2 cm below the umbilicus in the midline
- Right or left lower quadrant, approximately 4-5 cm medial to the anterior supine iliac spine
Procedure for Abdominal Paracentesis
- Perform hand hygiene. Don sterile gown, gloves, and mask.
- Use skin prep solution to clean skin over the proposed puncture site and drape to define a sterile field.
- Anesthetize the skin over the proposed puncture site with lidocaine drawn up in the 5-cm’ syringe with the attached 25-G needle. Anesthetize down to the peritoneum.
Aspirate periodically; if ascites fluid returns, withdraw the needle slightly to re-enter. tissue before further anesthetic is infiltrated. - Attach 18-G needle to free end of intravenous (IV) tubing, leave capped, and close valve tightly on the tubing.
- Puncture the rubber stopper of the vacuum bottle with the other end of the tubing.
- Insert the 18-G needle perpendicularly through the anesthetized abdominal wall and advance until hub of needle is 5 mm to 1 cm away from the skin surface.
- Open up the tubing clamp. Ascetic fluid should begin to flow into the bottle.
- When paracentesis is done, simply remove needle from abdominal wall.
- Place a small pressure dressing on puncture site.
Post procedure Care
- Have the patient remain supine for 2-4 hours.
- Monitor vital signs q1/2 hourly for 2 hours, q hour for 4 hours, and every 4 hours for 24 hours.
- Label the specimens and send them to the laboratory with due form.
- Record the amount and kind of fluid removed, number of specimens sent to laboratory, and the child’s condition through treatment.
- Watch for leakage after paracentesis.
Complications
- Hypovolemia leading to shock and collapse
- Infection (peritonitis)
- Injury to the blood vessels and other abdominal organs
- Renal failure due to reduced systemic circulations
- Hypoproteinemia
- Abdominal wall hematoma
- Persistent peritoneal leak
Nurse’s Responsibility
- Assist in preparing skin with antiseptic solution.
- Open sterile tray and package of sterile gloves and provide anesthetic solution.
- Have collection bottle and tubing available.
- Assess the pulse and respiratory status frequently during the procedure; watch for pallor, cyanosis or syncope and faintness.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Naveen Bajaj, Rajesh Kumar, Manual of Newborn Nursing, 2nd Edition, 2023, Jaypee Publishers, ISBN:978-9354659294.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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