Chapter 28. Paracentesis/Peritoneal Lavage

• • 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 bacterial peritonitis).

  • Therapeutic removal of the ascitic fluid (eg, chylous ascites, tense ascites, intestinal lymphangiectasia).

Absolute

• • Unstable airway.

  • Hemodynamically unstable patient.

  • Intestinal perforation.

Relative

• • 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.

• • Pneumoperitoneum.

  • Perforation: Intestine, solid organs.

  • Bleeding.

  • Infection.

• • Explain indication and risks to the patient and parents.

  • Inform the patient of the intention of the procedure.

• • Supine or side.

• • The preferred site is in the midline approximately one-third of the distance from the umbilicus to the symphysis pubis (Figure 28–1).

• • In infants, the fluid may bulge laterally, and the paracentesis may be obtained laterally to that point.

Paracentesis

• • 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).

• • Obtain a sample of fluid or withdraw as much fluid as necessary with a syringe (in case of therapeutic lavage) (Figure 28–3).

• • 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 IV.

Diagnostic Peritoneal Lavage

• • The puncture site should be shaved, if necessary, and cleaned ...