abdominal paracentesis, ap, abdominal tap

8/13/2019 Abdominal Paracentesis, AP, Abdominal Tap

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Assisting inAbdominal Paracentesis

By: Maria Decerie A. Penollera

BSNIV Neuman


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Definition

It is a sterile invasive procedureperformed by the physician toobtain peritoneal fluid from theperitoneal cavity through a small

opening or puncture madethrough the abdominal wall.


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Also known as Abdominal Tap

A strict sterile technique is to be followed

It is an outpatient procedure


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The Abdominal Wall


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4 Quadrants


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9 Regions of the Abdomen


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Purpose

Diagnostic

peritoneal fluid is analyzed to determine

the presence of bacteria, blood, glucose,and protein.

for cytologic analysis.

Palliative measures to provide temporary relief of respiratory

and abdominal discomfort caused by ascites

or reduce intraabdominal pressure


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Indication

New onset ascites or ascites of unknownorigin

Patients with ascites of known etiology whomay have a decompensation clinical state as

indicated by fever, painful abdominaldistention, peritoneal irritation, hypotension,encephalopathy or sepsis


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Indication Cont

Suspected malignant ascites

Peritoneal dialysis patients with fever,abdominal pain or other signs of sepsis(usually the paracentesis fluid may be

removed directly from the patients dialysiscatheter)


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Contraindication

Uncorrected bleeding diathesis

Previous abdominal surgeries withsuspected adhesions

Severe bowel distention/obstruction

Abdominal wall cellulitis at the proposedsite of puncture


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Contraindication Cont

Pregnancy

Organomegaly


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Assessment

Note for allergies of any medication

Note for bleeding problems

Patient is taking any blood thinningmedications

Check informed consent

Assess the knowledge of the patient


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Materials


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Materials cont

Specimen container

Big syringe (to aspirate)

Tubing

Trocar

Cannula

Aspirating set


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Materials cont

Antiseptics

Sponges Fenestrated drape

Small scalpel

Gloves and mask


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Materials cont

receptacle for fluid

1% or 2% lidocaine with epinephrinefor local anesthesia

If available, a bedside ultrasoundmachine is an asset


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1. Check doctors order and consent foroperation.

2. Prepare all needed materials.3. Explain the procedure to the client.

4. Do handwashing.

5. Premedicate the patient if indicated.

6. Have the patient void before beginning

the procedure.


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7. Position the patient sitting on theedge of edge of the bed.

8. Drape the patients back and legs.9. Set up the equipment on a

convenient overbed table, arranging

the sterile field.

10.Make sure that a straight chair isavailable.


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11.Observe the patient particularly forpallor, dizziness, faintness,

diaphoresis, and rapid pulse andrespirations.

12.Reassure the patient to relieve

anxiety throughout the procedure.13.Assist with the procedure, providing

equipment as needed.


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Site:

Right Lower

quadrant

Left Lower

quadrant

Midway between the umbilicus and the symphysis pubis

on the midline or 2 inch below the umbilicus


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14.Assist patient in assuming acomfortable position and allow a restperiod after the procedure.

15.Label and properly care for anyspecimen obtained.

16.Record amount and kind of fluidremoved, number of specimens sentto laboratory, patients condition

throughout treatment.


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17.Check / monitor BP, pulse rate andrespiratory rate every hour for 2

hours; every hour for 4 hours; andevery 4 hours for 24 hours.

18.Report to physician any untoward

signs or symptoms noted.19.Do after care of equipment used

20.Wash hands / do hanwashing.


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Documentation

Date and time performed

Primary care providers name

Abdominal girth before and after The color, clarity and amount of drained

fluid

Normal ascitic fluid: serous, clear, and light yellowin color

Nurses assessment and intervention.


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Complications

Hyponatremia

Bleeding

Intraabdominal injury

Inferior epigastric arterypuncture


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FIN!!

abdominal paracentesis, ap, abdominal tap

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