Procedure for Abdominal Paracentesis

PREPARATORY PHASE

ACTION
1. Explain procedure to the patient.
Rationale: This may reduce the patient’s fear and anxiety.

2. Record the patient’s vital signs.
Rationale: Provides baseline values for later comparison.

3. Have the patient void before treatment is begun. See that consent form has been signed.
Rationale: This will lessen the danger of accidentally piercing the bladder with the needle or trocar.

4. Position the patient in Fowler’s position with back, arms and feet supported (sitting on the side of the bed is frequently used position).
Rationale: The patient is more comfortable and steady position can be maintained.

5. Drape the patient with sheet exposing abdomen.
Rationale: Minimizes exposure of patient and keeps him warm.

PERFORMANCE PHASE

1. Assist physician in preparing skin with antiseptic solution.
Rationale: This is considered a minor surgical procedure, requiring aseptic precautions.

2. Open sterile tray and package of sterile gloves; provide anesthetic solution.

3. Have collection bottle and tubing available.

4. Assess pulse and respiratory status frequently during procedure; watch for pallor, or syncope.
Rationale: Preliminary indications for shock should be watched for. Keep emergency drugs available.

5. Physician administers local anesthesia and introduces No. 20 needle or trocar.

6. Needle or trocar is connected to tubing and vacuum bottle or syringe; fluid is drained from peritoneal cavity.
Rationale: Drainage is usually limited to 1-2 liters to relieve acute symptoms and minimize risk of hypovolemia and shock.

7. Apply dressing when needle is withdrawn.
Rationale: Elasticised adhesive patch is effective, serving as waterproof adhering dressing.

FOLLOW-UP PHASE

1. Assist the patient to be comfortable after treatment.

2. Record amount and kind of fluid removed, number of specimens sent to laboratory, the patient’s condition through treatment.

3. Check blood pressure and vital signs every half hour for two hours, every hour for 4 hours, and every 4 hours for 24 hours.
Rationale: Close observation will detect poor circulatory adjustment and possible development of shock.

4. Usually, a dressing is sufficient; however, if the trocar wound appear large, the physician may close the incision with sutures.

5. Watch for leakage and/or scrotal edema after paracentesis.
Rationale: If seen, notify the physician at once.


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