Assisting Of

Abdominal
Paracentesi
s
DEFINITION

paracentesis is the removal of fluid

from peritoneal cavity through a small
puncture made through the abdominal
wall under sterile conditions.
  TYPES

1. Diagnostic small quantity of fluid is removed for testing.

2. Therapeutic :1 to 5 litres of fluid is removed to reduce intra-abdominal

pressure and relieve the associate with Symptoms like dyspnoea,
abdominal pain and early satiety.
 PURPOSES
1. To provide comfort to the patient.

2. To relieve pressure on the abdominal and chest organs due to ascites.

3. To study chemical, bacteriological and cellular composition of peritoneal fluid for

diagnosis of disease.

4. To drain exudate in peritonitis.

5. To prepare for procedures like peritoneal dialysis.

 Indication
1. New onset ascites.
2. Testing of ascitic fluid.
3. For evaluation of patient with ascites who has signs of clinical deterioration like
fever, abdominal pain, hepatic encephalopathy, decreased renal function and
metabolic acidosis.
4. Paracentesis can identify unexpected diagnosis such as chylous, hemorrhagic or
eosinophilic ascites useful to know aetiology and antibiotic susceptibility.
Position
• Fowlers position should be used by the patient
confined to bed.
• Severe ascites – supine position
• Mild ascites- recumbent position.
• Place the patient in upright position on the edge of
the bed or in a chair with feet supported on a
stool.
 Needle insertion site

o Midline :2-3CM below the umbilicus.

o lateral :2-4 cm superomedial to anterior
iliac spine
 CONTRAINDICATIONS

a.Pregnancy
b.Distended urinary bladder
c.Abdominal wall cellulitis at the site of puncture.
d.Distended bowel
e.intra- abdominal adhesion
 Preparation of the articles
A sterile tray containing (abdominal tapping set)

Article Rationale
 5ml. syringe with needle.
 20ml syringe with Leur-Lock.
 Three-way adaptor and tubing. To administered local anaesthetic And drain out fluid
 IV set
 Trocar and cannula or aspiration needles
 Suturing needles (if incision is made). To make an incision , to insert into abdominal cavity
and drain out fluid.
 Sponge holding forceps.
 BP handle with blade (optional).
 Dissecting forceps To clean the skin .
 Artery clamp
 Specimen bottles.
To collect specimen.
 Sterile dressing articles.(cotto balls , gauze)
To clean the skin.
 Surgical towel To cover the area and maintain sterile field and
exposed only the required path.
 A clean tray containing

Article Rationale

 Gloves, gown and mask To keep the hand sterile and prevent from cross
infection.
 Mackintosh and towel.
 kidney tray. To protect bed linen and discard the waste .
 Spirit, iodine, tincture benzoin
To prepare the sterile field.

 Pint measure
To measure the abdominal fluid.
 Lignocaine 25% To anaesthetize the part.
 Preparation of the patient
 Explain the procedure to the patient.
 Obtain an informed consent
 Obtain coagulation profile and platelet count before beginning the procedure.
 Ask the client to void immediately prior to the procedure to decrease the risk of bladder
puncture.
 Position patient as required by the physician and according to patient condition Usual
position is supine with head of the bed elevated 45 to 90 degree or sitting over the side of
the bed.
 Provide privacy.
Sr
no
Procedure
Nursing action Rationale

1 Identify the patient and explain the procedure to the patient Wins confidence and
and relatives. 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 Promotes good body
position/Assist him to sitting position in a chair with legs mechanics and Fowler's
supported. position helps in shifting
fluid down.
6 Place sphygmomanometer cuff around patient's arm to Hypotension may occur.
monitor BP during the procedure
7 Wash hands and put on gloves Prevents transmission of
infection.
8 clean the area with antiseptic solution and assist Reduces risk of infections.
the physician administer local anaesthesia. Drape
patient with sterile towels.
9 Assist the physician in inserting trocar and cannula The greater the vertical distance
into the abdomen below the umbilicus. Remove the between the needle and receptacle
trocar and attach the cannula to the tubing which the greater will be the pull on the
reaches the receptacle which is placed on a low stool 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 liters) remove Pressure dressing and bandage
the cannula and place a tincture benzoin seal, sterile helps to prevent leakage of fluid.
dressing and pressure bandage over puncture site.
12 Check the patients general condition after procedure. Vital signs To comfortable the patient and
are checked every 15 minutes for 2 hours, then 30 minutes for 7 check any untoward sign
hours. Examine the dressing for any leakage symptoms.
13 Measure and describe the fluid collected and To rule out bacteriological
send the specimen to laboratory with labels and chemical composition
and requisition forms. of fluid and to diagnose the
disease
14 Record the procedure, date, time, amount of To measure accurately , to
fluid collected, nature of fluid colour and know the amount ,colour and
general condition of patient during and after consistency of fluid.
procedure Include amount of fluid tapped in the
pas 24 hour output.
15 The equipment to be removed from bed side, To neatness the unit and
tidy up the unit after making the client comfort the patient.
comfortable.
16 clean Wash with soapy water, rinse and dry it Prevents cross infections.
Send for autoclaving.
 NURSING CONSIDERATION

 Fluid specimen for laboratory analysis.

 Record amount characteristics of fluid, number of specimens sent to laboratory.
 Patient's condition during treatment.
 Check vital signs every half hour for two hours, every hour for four hours and every four
hour for 24 hours.
 Watch for leakage or scrotal oedema after paracentesis.

Observe the site for bleeding

 COMPLICATIONS

 Perforation of bowel or bladder.

 Local or systemic infection.

 Hypovolemia, hypotension.

 Bleeding from paracentesis site.

 Ascites leak from paracentesis site.

SUMMARY
Abdominal paracentesis is a bed side clinical procedure in which
needle is inserted into peritoneal cavity and ascitic fluid is removed.
Diagnostic paracentesis removes a small amount for testing, while
therapeutic paracentesis removes five liters or more to reduce intra-
abdominal pressure The procedure is performed by trained clinicians,
sometimes with a dedicated team using ultrasound guidance.
CONCLUSION

Paracentesis is performed to relieve intra abdominal and diaphragmatic

pressures and diminishing the work of breathing. It can be performed for
both diagnostic and therapeutic purposes. The nurse who assists for
paracentesis should know the anatomy and physiology of the lower
quadrant of the abdomen and the normal and abnormal composition of
peritoneal fluid.
 BIBLIOGRAPHY
1. Sandra MN. The Lippincott manual of nursing practice. 7th ed. Lippincott: Jaypee brothers; 2003. P. 645-6.

2. Black JM, Jane HH. Medical surgical nursing. 7th ed..Missouri: Elsevier; 2005. P.1509-21.

3. 3. PR Ashalata, "Textbook of anatomy and physiology", 4th Edition, Jaypee publication, page no.383 to 431

4. Rochelle LB, Maribeth. American association of critical care nurses, procedure manual for critical care.
Philadelphia: WB Saunders company; 1993. P. 549-53.
5. https://www.slideshare.net/slideshow/abdominal-paracentesis-40281843/40281843#22

6. Zaki ZSA. Nurses' performance regarding abdominal paracentesis procedure for critically ill patients.
Egyptian Journal of Health Care. 2024 Dec;15(4). Available from:
https://ejhc.journals.ekb.eg/article_399098_86fbb1548deaf8315d0758ba12a760b9.pdf .