Patient Education and ConsentExplain the procedure, benefits, risks, complications, and alternative options to the patient or the patient's representative, and obtain signed informed consent. EquipmentThe equipment required can be found in a disposable paracentesis/thoracocentesis kit (see the image below).  Equipment includes the following:
Patient PreparationAnesthesiaLocal anesthesia with injection of lidocaine is employed. (See Technique.) For more information, see Local Anesthetic Agents, Infiltrative Administration. PositioningPatients with severe ascites can be positioned supine. Patients with mild ascites may need to be positioned in the lateral decubitus position, with the skin entry site near the gurney. The lateral decubitus position is advantageous because air-filled loops of bowel tend to float in a distended abdominal cavity. The two recommended areas of abdominal wall entry for paracentesis are as follows (see the image below):
The authors recommend the routine use of ultrasonography (US) to verify the presence of a fluid pocket under the selected entry site in order to increase the rate of success (see the image below). [31] Performing US also helps the practitioner avoid a distended urinary bladder or small-bowel adhesions below the selected entry point. To minimize complications, it is important to avoid areas of prominent veins (caput medusae), infected skin, or scar tissue.
Author Coauthor(s) Specialty Editor Board Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose. Chief Editor Vikram Kate, MBBS, PhD, MS, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, FFST(Ed), MAMS, MASCRS Professor of General and Gastrointestinal Surgery and Senior Consultant Surgeon, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), India Vikram Kate, MBBS, PhD, MS, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, FFST(Ed), MAMS, MASCRS is a member of the following medical societies: American College of Gastroenterology, American College of Surgeons, American Society of Colon and Rectal Surgeons, Fellow of the Faculty of Surgical Trainers (RCSEd), Royal College of Physicians and Surgeons of Glasgow, Royal College of Surgeons of Edinburgh, Royal College of Surgeons of England, Society for Surgery of the Alimentary Tract Disclosure: Nothing to disclose. Additional Contributors Andrew K Chang, MD, MS Vincent P Verdile, MD, Endowed Chair in Emergency Medicine, Professor of Emergency Medicine, Vice Chair of Research and Academic Affairs, Albany Medical College; Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Attending Physician, Department of Emergency Medicine, Montefiore Medical Center Andrew K Chang, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American Academy of Pain Medicine, American College of Emergency Physicians, American Geriatrics Society, American Pain Society, Society for Academic Emergency Medicine Disclosure: Nothing to disclose. Acknowledgements The Chief Editor would like to acknowledge the assistance of Dr Mohsina Subair, former Senior Resident, Department of Surgery; Dr Archana Elangovan, former Senior Resident, Department of Surgery; Dr Gurushankari Balakrishnan, Senior Resident, Department of Surgery; and Dr Evangeline Mary Kiruba Samuel, Junior Resident, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India, in updating the review of this article. Medscape Drugs & Diseases also thanks George Y Wu, MD, PhD, Professor, Department of Medicine, Director, Hepatology Section, Herman Lopata Chair in Hepatitis Research, University of Connecticut School of Medicine, for assistance with the video contribution to this article. |
What instructions should the client be given before undergoing a paracentesis?
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