Definition
Abdominal Paracentesis is the removal of fluid from peritoneal cavity through a small puncture made through the abdominal wall under sterile conditions.
Purposes
- To relieve pressure on the abdominal and chest organs due to ascites.
- To drain exudate in peritonitis.
- To study chemical, bacteriological and cellular composition of peritoneal fluid for diagnosis of disease.
- To prepare for procedures, such as peritoneal dialysis.
Articles
A sterile tray containing (abdominal tapping set) the following:
- Sponge holding forceps.
- 5 ml syringe with needle.
- 20 mL syringe with Luer-lock.
- Three-way adaptor and tubing.
- Trocar and cannula or aspiration needles.
- BP handle with blade (optional).
- Suturing needles (if incision is made).
- Dissecting forceps.
- Specimen bottles.
- Sterile dressing articles.
- Artery clamp.
- Surgical towel.
A clean tray containing the following:
- Mackintosh and towel.
- Kidney tray.
- Spirit, iodine, and tincture benzoin.
- Lignocaine 2%.
- Apron.
- Drainage receptacle.
- Pint measure.
- Measuring tape.
- IV set.
- IV bottle.
- Gloves, gown, and mask.
Additional Articles
- Back rest.
- Low stool.
- Additional pillows.
Preparation of the Patient
Preparing to assist in an abdominal paracentesis procedure involves several key steps to ensure patient safety and the effectiveness of the procedure.
- Medical History Review:
- Confirm the patient’s medical history, including liver disease, kidney failure, or bleeding disorders.
- Ensure the patient has voided before the procedure to prevent bladder injury.
- Dietary and Medication Adjustments:
- Patients may be advised to avoid eating or drinking for a few hours before the procedure.
- Blood-thinning medications may need to be adjusted to reduce the risk of bleeding.
- Bowel Preparation:
- No specific bowel preparation is required, but the patient should be comfortable and relaxed.
- Consent and Communication:
- Explain the procedure to the patient, addressing any concerns or questions.
- Obtain informed consent before proceeding.
Procedure
| Nursing action | Rationale | |
| Before procedure | ||
| 1. | Identify the patient and explain the procedure to the patient and relatives. | Wins confidence and cooperation from patient. |
| 2. | Measure abdominal girth and weight of the patient. | Provides baseline data. |
| 3. | Obtain informed consent. | Avoids legal problems. |
| 4. | Instruct the patient to void 5 minutes before the procedure. | Prevents risk of injury to bladder. |
| 5. | Bring the patient to the edge of bed. Place him in Fowler’s position/assist him to sitting position in a chair with legs supported. | Promotes good body mechanics and Fowler’s position helps in shifting fluid down. |
| 6. | Place sphygmomanometer cuff around patient’s arm to monitor BP during the procedure. | Hypotension may occur. |
| During procedures | ||
| 7. | Wash hands and put on gloves. | Prevents transmission of infection. |
| 8. | Clean the area with antiseptic solution and assist the physician to administer local anesthesia. Drape patient with sterile towels. | Reduces risk of infections. |
| 9. | Assist the physician in inserting trocar and cannula into the abdomen below the umbilicus. Remove the trocar and attach the cannula to the tubing which reaches the receptacle which is placed on a low stool. | The greater the vertical distance between the needle and receptacle the greater will be the pull on the fluid thus the cavity is drained more quickly and the patient may develop hypotension. |
| 10. | Collect specimen in sterile bottles. | |
| 11. | After enough fluid is withdrawn (1-2 L) remove the cannula and place a tincture benzoin seal, sterile dressing and pressure bandage over puncture site. | Pressure dressing and bandage helps to prevent leakage of fluid. |
| 12. | Check the patient’s general condition after procedure. Vital signs are checked every 15 minutes for 2 hours and then 30 minutes for 2 hours. Examine the dressing for any leakage. | |
| After procedure | ||
| 13. | Measure and describe the fluid collected and send the specimen to laboratory with labels and requisition forms. | To rule out bacteriological and chemical composition of fluid and to diagnose the disease. |
| 14. | Record the procedure, date, time, and amount of fluid collected, nature of fluid, color and general condition of patient during and after the procedure. Include amount of fluid tapped in the patient’s 24 hours output. | |
| 15. | Clean all articles used. Wash with soapy water, rinse, and dry it. Send for autoclaving. | Prevents cross infections. |
Special Consideration
- Confirm the patient’s medical history, including liver disease, kidney failure, or bleeding disorders.
- Ensure the patient has voided before the procedure to prevent bladder injury.
- Blood-thinning medications may need to be adjusted to reduce the risk of bleeding.
- Monitor for any contraindications, such as severe coagulopathy or infection at the puncture site.
- Maintain strict sterile conditions to minimize the risk of infection.
- Ensure all equipment, including the paracentesis tray, antiseptic solution, and local anesthetic, is properly prepared.
- Assist the patient into a semi-Fowler’s position or sitting upright to allow optimal access to the peritoneal cavity.
- Ensure the patient remains still to prevent accidental injury.
- Observe the patient for signs of discomfort, dizziness, or complications such as hypotension.
- Ensure fluid removal is controlled to prevent sudden shifts in blood pressure.
- Monitor for delayed complications, such as bleeding, infection, or hypotension.
- Encourage hydration and rest, and provide follow-up instructions.
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 Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- 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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