Abdominal paracentesis Geniuses home.pptx

,abdominalparacentesis,newonsetascitesascitesofunknownoriginsuspectinginfectionsymptomatictreatmentoflargeascites,indications,uncooperativepatientuncorrectedbleedingdiathesisacuteabdomenthatrequiressurgeryintra-abdominaladhesionsdistendedboweldistendedurinarybladderabdominalwallcellulitisatthesiteofpuncturepregnancy,contraindications,equipment,commercialparacentesiskitsarepre-assembled.ifnotavailable,youwillneed:16gcatheter10ccsyringelidocaine1%one-litervacuumbottlethoracentesiskittubing,steriledrapessterileglovesantisepticsterilegauzeplasterspecimencontainer,identifyyourpatient,introduceyourselfexplaintheproceduretothepatientandobtainawritteninformedconsent,ifpossible.explaintheindication,risks,benefitsandalternatives.preparetheappropriateequipmentaskthepatienttourinatebeforetheproceduretoemptythebladder.,beforetheprocedure,positionthepatientinthebedwiththeheadelevatedat45-60degrees,tiltthepatienttowardthesiteofparacentesis(allowfluidtoaccumulateinlowerabdomenandair-filledloopsofboweltendtofloattotheothersite,thiswillminimizetraumatobowel).ultrasoundscantoidentifythepresenceofencystedascitestoavoiddistendedbladder,smallboweladhesions,largeveins.howdeeptoinserttheneedle,thetworecommendedareasofabdominalwallentryforparacentesisareasfollows:2cmbelowtheumbilicusinthemidline5cmsuperiorandmedialtotheanteriorsuperioriliacspinesoneitherside,technique,explainwhatisgoingonwhileperformingtheprocedure,thiswillalleviatethepatientsanxiety.wearsterileglovescleantheareawithantisepticsolutioninacircularfashionfromthecenterout.,applythesteriledrapes.youwillplacetheopenedpartsofthekitonthedrape.openthe16gangiocathandsyringeplacethemonthesteriledrapes.placethe1-lvacuumbottlesnearby.administerlidocaineattheinsertionsite,usescalpelbladetomakeasmallnickintheskintoallowaneasiercatheterpassageinserttheneedleinz-techniqueinserttheneedledirectlyperpendiculartotheselectedskinentrypoint.slowinsertioninincrementsof5mmispreferredtominimizetheriskofinadvertentvascularentryorpunctureofthesmallbowel.,continuouslyapplynegativepressuretothesyringeastheneedleisadvanced.uponentrytotheperitonealcavity,lossofresistanceisfeltandasciticfluidcanbeseenfillingthesyringe.atthispoint,advancethedevice2-5mmintotheperitonealcavitytopreventmisplacementduringcatheteradvancement.ingeneral,avoidadvancingtheneedledeeperthanthesafetymarkthatispresentonmostcommerciallyavailablecathetersordeeperthan1cmbeyondthedepthatwhichasciticfluidwasnoticed.,useonehandtofirmlyanchortheneedleandsyringesecurelyinplacetopreventtheneedlefromenteringfurtherintotheperitonealcavityusetheotherhandtoholdthestopcockandcatheterandadvancethecatheterovertheneedleandintotheperitonealcavityallthewaytotheskin,theself-sealingvalvepreventsfluidleak.attachthe60-mlsyringetothe3-waystopcockandaspiratetoobtainasciticfluidanddistributeittothespecimenvialsandsendittothelabforanalysis,connectoneendofthefluidcollectiontubingtothestopcockandtheotherendtoavacuumbottleoradrainagebagiftheflowstops,kinkorclaspthetubingtoavertlossofsuction,thenbreakthesealandmanipulatethecatheterslightly,thenreconnectandseeifflowresumes.,postprocedure,removethecatheterafterthedesiredamountofasciticfluidhasbeendrained.applyfirmpressureplacesterilegauzeabandageovertheskinpuncturesite.askthepatienttoliefor4hoursandthenursetocheckvitalsignseveryhourfor4hourstoavoidhypotension.give25ccofalbumin(25%solution)forevery2litersofasciticfluidremoved.,writeaprocedurenotewhichdocumentsthefollowing:patientconsentindicationsfortheprocedurerelevantlabs,e.g.inr/ptt,plateletcountproceduretechnique,sterileprep,anesthetic,amountoffluidobtained,characteroffluid,estimatedbloodloss.anycomplicationslabtestsrequested.color,ph,protein,albumin,specificgravity,glucose,bilirubin,amylase,lipase,triglyceride,ldh,cellcounttotalanddifferential,culture&sensitivity,gramstain,afb,cytology,persistentleakfromthepuncturesiteabdominalwallhematomaperforationofbowelintroductionofinfectionhypotensionafteralarge-volumeparacentesisdilutionalhyponatremiacatheterfragmentleftintheabdominalwallorcavity,complications,thoracosentesis,symptomatictreatmentoflargepleuraleffusionstreatmentofempyemadiagnosisofunderlyingcauseofpleuraleffusions,indication,therearenoabsolutecontraindicationsforthoracentesis.relativecontraindicationsincludethefollowing:uncorrectedbleedingdiathesischestwallcellulitisatthesiteofpuncture,contraindications,equipment,thoracosentesissetifnotavailableassemblethefollowings:syringe-10mlsyringe-5mlsyringe-60mltubingsetwithaspiration/dischargedeviceantisepticsolutionlidocaine1%solution,specimencapfor60-mlsyringespecimenvialsorbloodtubesdrainagebagorvacuumbottlesteriledrapessteriletowelsscalpeladhesiveplastersterilegauzesurgicalgloves,identifyyourpatient,introduceyourselfexplaintheproceduretothepatientandobtainawritteninformedconsent.explaintheindication,risks,benefitsandalternatives.preparetheappropriateequipmentgivethepatientanxiolytics(ivmidazolamorlorazepam)toattenuatetheanxiety.,beforetheprocedure,placethepatientinaseatedposition,leaningslightlyforwardandrestingtheheadonthearmsorhandsoronapillow,whichisplacedonanadjustablebedsidetable.thispositionfacilitatesaccesstotheposterioraxillaryspace,whichisthemostdependentpartofthethorax.,technique,explainwhatisgoingonwhileperformingtheprocedureafterpositioningultrasonographyisperformedtoconfirmthepleuraleffusion,assessitssize,lookforloculations,determinetheoptimalpuncturesiteandminimizecomplicationstheoptimalpuncturesitemaybedeterminedbysearchingforthelargestpocketoffluidsuperficialtothelung,washwithantisepticsolutionplacedsteriledrapeoverthepuncturesitetheskin,subcutaneoustissue,ribperiosteum,intercostalmuscles,andparietalpleurashouldbewellinfiltratedwithanestheticlidocaineusescalpelbladetomakeasmallnickintheskintoallowaneasiercatheterpassage,thedeviceisadvancedoverthesuperioraspectoftheribwhileapplyingnegativepressureuntilpleuralfluidisobtainedtheneurovascularbundleislocatedattheinferiorborderoftheribandshouldbeavoided.at5cmdepth(markonthedevice),thehemithoraxisusuallyentered,andtheneedledontneedbeadvancedanyfurther.,advancethecatheterovertheneedleandintothepleuralcavityallthewaytotheskin(ifpossible).,connectthecathetertosyringeorvacuumbottle,thepleuraleffusionisdraineduntilthedesiredvolumehasbeenremovedforsymptomaticreliefordiagnosticanalysis,postprocedure,removethecatheterafterthedesiredamountofpleuralfluidhasbeendrained.applyfirmpressureandplacesterilegauzeandbandageovertheskinpuncturesitepositionthepatientontheunaffectedsidefor1hour.thisallowsthepleuralpuncturetohealgiveanalgesiafrequentlycheckvitalsigns,oxygensaturationandbreathsoundstodetectcomplicationssendsampleforanalysiswriteprocedurenoterequestcxrtocheckforpneumothorax,complications,majorcomplicationsincludethefollowing:pneumothoraxhemothoraxlacerationoftheliverorspleendiaphragmaticinjuryempyematumorseeding,minorcomplicationsincludethefollowing:paindrytapcoughsubcutaneoushematomasubcutaneousseromavasovagalsyncope,chestaspirationfortensionpneumothorax,tensionpneumothorax,atensionpneumothoraxisalife-threateningconditionthatdevelopswhenairistrappedinthepleuralcavityunderpositivepressure,displacingmediastinalstructuresandcompromisingcardiopulmonaryfunction,60mldisposablesyringe3-waystopcockcannulasize16antisepticsterilegloves,equipment,explaintheproceduretothepatient(inshortterms)andobtainpermissionprepareyourequipmentpositionthepatientinthesupineposition.,beforetheprocedure,washwithantisep