Definition

Abdominal paracentesis is a procedure done to remove the accumulated fluid in the abdominal cavity (peritoneal fluid) in a condition called ascites.

Causes of Ascites

• Slowing of venous return in congestive heart failure
• Portal hypertension e.g. liver cirrhosis
• Tuberculosis
• Abdominal malignancy
• Alcoholic hepatitis
• Portal vein thrombosis
• Nephrotic syndrome
• Malnutrition

Reason /indication/ Purpose of Abdominal Paracentesis

1. To find the cause of ascites. Doctors can know why fluid has collected in the abdomen, whether it is tuberculosis, malignancy, or other causes.
2. To examine the abdominal fluid by looking at the colour, cells, protein, and germs in the peritoneal fluid.
3. To relieve abdominal discomfort, for example pain and tightness.
4. To help the patient breathe better by relieving pressure on the lungs after fluid removal.
5. To treat severe or recurrent ascites. This is used when medicines do not work well.
6. To reduce abdominal pressure, preventing complications from too much pressure in the abdomen.
7. To guide treatment. Test results help decide medicines and care.
8. To collect a sample.

Site and Position use when carrying out Abdominal Tapping

Site: Left iliac fossa, midway between the symphysis pubis and the umbilicus. This site is also used to avoid injury to the bladder and other abdominal organs.

Position: Sitting-up position.

Setting a Trolley for Abdominal Tapping

The setting for abdominal tapping should be a sterile trolley. Arrange requirements from bottom to top.

Top Shelf

• Draper or spitting towel
• Artery forceps
• Sterile hand towel
• Dissecting forceps
• Small scalpel blade
• Trocar and a cannula
• Gallipot for swabs, gauze, antiseptic
• Receiver for used swabs
• Rubber tubing and towel clip
• Suturing pack (scissors, needle holder, forceps, sutures)

Bottom Shelf

• Four receivers for used swabs, gauze, hand towel, instruments
• 10 mls syringe
• 2 pairs of sterile gloves
• Drainage bottle with measured antiseptic
• Roll of strapping with clean scissors
• Emergency tray with drugs
• Tape measure
• Bottle of iodine and measuring jar
• Mackintosh and towel
• Many-tailed bandage or binder
• Specimen bottles and lab request form
• Lignocaine and two aprons
• Floor mackintosh
• Safety pin
• Fluid balance chart
• Cheatle forceps
• Drum of sterile cotton and gauze

Bedside: Hand washing equipment, screen, stool

Procedure

1. Explain the procedure to the patient and obtain consent.
2. Screen the bed to provide privacy.
3. Bring trolley to bedside.
4. Position patient sitting-up, supported, to allow fluid accumulation.
5. Wash hands and put on gloves.
6. Provide bedpan to patient.
7. Expose abdomen, cover chest to prevent coldness.
8. Doctor cleans skin between umbilicus and pubis.
9. Inject lidocaine (local anaesthetic).
10. Insert cannula and collect specimen if needed.
11. Connect tubing and drain fluid into bottle.
12. Secure cannula with strapping.
13. Apply many-tailed bandage and safety pin.
14. Clear trolley and emergency tray.
15. Monitor vital signs every 15 minutes.
16. Inspect bandage; reapply if loose.
17. Remove cannula after drainage.
18. Seal puncture site with sterile dressing.
19. Measure and record fluid amount and colour.
20. Inform patient of fluid drained and thank them.

Complications of Abdominal Paracentesis

• Bleeding or haematoma
• Infection
• Bowel perforation
• Hypotension (low blood pressure)
• Shock (paracentesis-induced circulatory dysfunction)
• Pain or discomfort
• Allergic reaction to local anaesthetic
• Electrolyte imbalance
• Persistent fluid leakage

Nurse’s Role in Abdominal Paracentesis

• Explain procedure to reduce anxiety.
• Assess patient’s condition (vitals, distension, pain).
• Review investigations and report abnormalities.
• Obtain informed consent.
• Prepare patient (empty bladder, position sitting-up).
• Prepare sterile trolley.
• Assist doctor during procedure.
• Maintain patient comfort and monitor pain.
• Monitor vitals and fluid characteristics.
• Apply dressing and many-tailed bandage.
• Monitor site for bleeding or leakage.
• Assess for complications.
• Measure and document fluid drained.
• Send specimens to lab.
• Educate patient to report pain or dizziness.

Signs and Symptoms to Report After Abdominal Tapping

• Severe or increasing abdominal pain
• Persistent leakage of fluid from puncture site
• Bleeding from puncture site
• Fever or chills
• Dizziness or fainting
• Shortness of breath
• Swelling, redness, or warmth at site
• Nausea or vomiting
• Reduced urine output
• Rapid heartbeat or weakness