After a small hiatus, MR is back with Dr. Reisman presenting today’s special Halloween edition! (sorry nothing really Halloween related but still good stuff!)
Abdominal Paracentesis: prevention and management of persistent ascites leak
Diagnostic paracentesis
– New onset ascites
– Patient with ascites and signs of SBP
Therapeutic paracentesis
– Removal of fluid to reduce pain or dyspnea
Elevated INR and thrombocytopenia are not contraindications
Technique to avoid ascites leak
Traditional location: 3cm above and 3cm medial to the ASIS
Or use ultrasound to find the best location
Use the Z-track technique when infiltrating lidocaine and when inserting the paracentesis needle:
- Pull the skin downward with the non-dominant hand, and continue
to put traction on the skin until the needle has entered the peritoneal cavity - Insert the needle with your dominant hand
- Avoid the use of a needle with a plastic catheter or sheath
- Remove the needle in one rapid, smooth movement when finished
Management of persistent fluid leak:
- Place ostomy bag over the leak site
- Place figure of 8 stitch over the site
- Use dermabond!
When using dermabond, use a high flow nasal cannula taped to the skin to dry the ascites fluid and allow you to apply the glue. Use multiple layers.
Jay Khadpe MD
- Editor in Chief of "The Original Kings of County"
- Assistant Professor of Emergency Medicine
- Assistant Residency Director
- SUNY Downstate / Kings County Hospital
Latest posts by Jay Khadpe MD (see all)
- Save of the Month! December 2015 - December 23, 2015
- Morning Report: Unprovoked First Seizure in Adults - September 11, 2015
- Morning Report: Extramural Deliveries in the Emergency Room - September 10, 2015
0 Comments