• Diagnostic sampling of ascitic fluid (eg, internal
bleeding following blunt abdominal trauma, chylous ascites after surgery,
rule out malignancy, identification of infectious organism in spontaneous
• Therapeutic removal of the ascitic fluid (eg, chylous ascites,
tense ascites, intestinal lymphangiectasia).
• Infection of the abdominal wall.
• Coagulopathy (prothrombin time > 18 seconds).
• Thrombocytopenia (platelet count < 100,000/mcL).
• Recent intestinal tract surgery (< 1 month ago).
• Alcohol swabs, povidone-iodine.
• 23-gauge and 21-gauge needles or angiocatheters with syringes.
• Local anesthetic (eg, 1% lidocaine).
• Large bore needle with plastic catheter.
• Sterile containers for fluid collection.
• Appropriate culture tubes for microorganisms.
Anatomic landmarks and sites of entry.
• The puncture site should be shaved, if necessary,
and cleansed with povidone-iodine.
• Inject local anesthetic, infiltrating the skin first and then penetrating
into deeper layers.
• A small 3-mm incision can be made with a scalpel to help insert
the needle. Using Z-track technique, insert the tap needle 1–2
inches into the abdomen (Figure 28–2).
• Remove the needle and apply a pressure dressing
to the puncture site.
• If an incision was made, it may be closed using 1 or 2 stitches.
• The ascitic fluid removed may be replaced 1:1 with 5% albumin
The Z-track. A: Needle
is inserted perpendicular to skin while skin is pulled taut. B: Sagittal view. C: Alternatively,
needle can be inserted at 45 degrees to skin and aimed caudally. D: Resultant Z-track (arrows).
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