ABDOMINAL PARACENTESIS
Abdominal paracentesis is the removal of fluid from the peritoneal cavity. Like pleural cavity, the peritoneal cavity is a also formed by two layers of serous membranes the visceral layer surrounding the abdominal organs and a parietal layer lining the abdominal cavity. Normally the peritoneal cavity is only a potential cavity separated by a thin film of serous fluid to lubricate the surfaces of peritoneum and prevent friction. In healthy body, the fluid formed in the peritoneal cavity is absorbed into the lymph circulation through the lymph vessels in the peritoneum. In disease processes, fluid accumulates within this cavity and cause ascites. Methods of treatment include restriction of sodium intake administration of diuretics and occasionally an abdominal paracentesis. Purpose of Abdominal Paracentesis
1. To pressure on the abdominal and chest organs if a transudate collects as a result
of renal, cardiac or liver diseases.
2. To study chemical, bacteriological and cellular composition of the peritoneal fluid
for the diagnosis of diseases.
3. To remove fiuid and instill air to create artificial. 4. To remove fiuid and instill air to create artificial pneumopertoneum as a treatment
for pulmonary tuberculosis affecting the base of the lungs. Site and positioning of the Client for an Abdominal Paracentesis The primary object of selecting a site is to avoid injury to the urinary bladder and other abdominal organs. A common site is the midway between the symphysis publs and the umbilicus on the midline. An another site may be a point two-third along a line from the umbilicus to the anterior superior iliac spine. The client is positioned in fowlers position supported bye back rest and pillows near the edge of the bed.
COMPLICATIONS
1. 2. 3. 4. 5.
Hypovolaemia leading to shock and collapse. Infection (peritonitis) Injury to the blood vessels and other abdominal organs. Renal failure due to reduced systemic clrculation. Hypoproteinaemia as a result of repeated taping.] 1
A covered sterile try containing : 1. 2. 3. 4. 5. 6. Sponge holding forceps to clean the skin. Syringe (5ml) with needles to give local anaesthesia. Syringe (20ml) with leur lock for aspiration of fluid. Three- way adaptor and turbing. Trocar and cannula or aspiration needles B.P. handle with blades to make a small skin incision for the introduction of trocar and cannula. 7. 8. 9. 10. 11. 12. 13. Suturing needles (if incision is made) Small bowls to take cleaning lotions. Dissecting forceps toothed 1, non toothed 1 Specimen bottles. Sterile dressing towels or slits. Cotton balls, gauze pleces, and cotton pads. Gloves, gown and mask.
An unsterile tray containing : 1. 2. 3. 4. 5. 6. 7. 8. Mackintosh and towels. Kidney tray and paper bag. Spirit, iodine, tr. benzoin etc. Lignocaine 2 per cent. Apron for the doctor. Drainae receptacle to collect the fluid. pint measures to measure the fluid. Low stool to raise the drainage receptacle and adjust the height.
PROCEDURE The abdominal paracentesis is done under strict aseptic techniques. If it is done for diagnostic purposes, the fluid withdrawn be a large syringe may be sufficient. If the
procedure is done for relieving pressure symptoms, a trocar and cannula are used. After giving a local anesthesia, a small skin incision is made at the site selected and the trocar and cannula are introduced. After the trocar and cannula are in position the trocar is removed and the cannula is attached to the tubing that reaches the drainage receptacle. Occasionally, a soft
catheter is passed through the cannula into the peritoneal cavity for the removal of fluid. After enough fluid is withdrawn, the cannula is removed and opening is sealed.
GENERAL INSTRUCTIONS 1. Give adequate explanations to win the confidence and co-operation of the client. Clients co-operation is very necessary, for the prevention of injury to the adjacent organs. 2. Strict aseptic technique should be followed to prevent introduction of infection into the peritoneal cavity. 3. Ask the client to void 5 minutes before the procedure to prevent injury to the bladder. Catheterize the client if any doubt exists. 4. 5. Keep the client warm and cornfortable to prevent chills. Be prepared to treat shock. Shock can be prevented by: (a) Withdrawing the fiuid slowly. Apply clamps on the turbing. (b) Withdrawing small quantity of fiuid at a time. (c) Applying pressure on the abdomene with many tailed bandage and tightening it from above downwards as the fiuid is drained. (d) Keeping the client warm. (e) Observing the vital signs continuously during the procedure. 6. The drainage receptacle should be raised on the stool. The greater the vertical distance between the tapping needle and the end of the tubing in the drainage receptacle, the greater is the pull on the fluid in the cavity and more quickly the cavity is drained and the client may go into a state of shock. 7. Use a tapping needle/ trocar of smaller gauge possible. The will reduce the puncture wound as small as possible and thereby reduce the chances of fiuid leaking from the peritoneal cavity after the procedure is over. 8. 9. The flow of fluid can be controlled by the application of clamps on the tubing. The nurse should remain with the client throughout the procedure to observe the clients general condition. Changes in colour, pulse, respiration, blood pressure etc. should be noted and reported to the doctor immediately. These are the indications that the client is gong into vascular shock and collapse. 10. Repeated aspirations of the ascetic fiuid will result in hypoproteinaemla. The client should be given plasma proteins if he develops such a condition.
11.
The wound should be sealed immediately after the procedure to prevent infection and leakage of peritioneal fiuid
12.
The specimens collected should be sent to the laboratory without delay. The suual test that are carried out are specific gravity, cell count, bacterial count, protein concentration, culture, acid fast stain. In most disorders, the fluid is clear and straw coloured. Turbidity suggests infection. Sanguineous fluid usually signals neoplasm or tuberculosis. The rare milky (chylous) fluid is dur to lymphoma. A protein concentration of less than 3gm /100 ml suggests liver diseases or a systemic such as tumor or an infection.
Preparation of the Client 1. Explain the procedure to the client and his relatives to obtain their understanding co-operation and acceptance of the treatment. 2. 3. 4. Get a written consent from the client or his relatives. Prepare the skin for a surgical procedure. Record the blood pressure, pubic, respiration and weight of the client on the nurses record before sending the client to the operation room. This may be used to compare the similar data obtained during or after the procedure and to determine the effect of the procedure on the client. 5. Empty the bladder just before the procedure to prevent injury to the distended bladder. When there is doube, catheterize the bladder. 6. Protect the from chills by keeping him warm. Cover the client with a blanket. Close the windows and doors to prevent draught. Put off the fan. 7. Change the clients garments with hospital dress. Put on loose gowns. The upper garments may be pinned up to prevent its falling over the abdomen during the procedure. 8. Bring the client to the edge of the bed to prevent over reaching place him in a Fowlers position supported with a back rest and pillows. 9. Maintain privacy with screens and drapes. Drape the client exposing the abdomen only. 10. 11. Protect the bedding with a mackintosh and towel. Protect a many tailed bandage under the client to apply over the abdomen during the procedure in order to maintain the intra-abdominal pressure. This
will heop to prevent shock and collapse as the fluid is drained from the abdominal cavity. 12. The nurse should remain with the client throughout the procedure encouraging him to co-operate and diverting the attention away from the procedure. She should note the colour, pulse, respiration and blood pressure during the procedure to detect the early signs of shock and collapse.
After Care of the Client 1. As soon as the needle is removed, a sterile dressing and a pressure bandage is applied at the puncture site to prevent leakage of fluid. 2. 3. The abdominal bandage is tightened to maintain intra-abdominal pressure. Check the clients general condition after the procedure. Any change in the colour. Pulse, respiration and blood pressure should be reported immediately. The vital sitns are checked half hourly for two hours; then hourly for 4 hours followed by 4 hours for 24 hours. 4. The specimen collected should be sent to the laboratory with labels and requisition form. 5. Examine the dressing at he puncture site frequently for any leakage, Reenforce the dressing if leakage is present. 6. Serum proteins are estimated to detect hypoproteinaemia. If hypoprotinaemia is present, plasma proteins are administered. 7. Record the procedure on the nurses record with date and time. Note the amount and character of the fluid drained, its colour, effects of treatment on the client (both desired and undesired effects) and the general condition of the client during and after the treatment. 8. Clean all the articles used. Wash with cold water and then with warm soapy water and rinse them in clean water. Dry and sent for autoclaving.
