Assisting with Paracentesis

A. Direction: Write your answers on the space provided.

Assessments:
 Identify the purpose of the abdominal paracentesis;
 Check allergies to medications or anesthetic, bleeding problems, medications currently using
including aspririn or if client might be pregnant.
 Assess client’s knowledge regarding abdominal paracentesis.
 Assess the client for bleeding tendencies to determine the risk of bleeding during and after the
procedure.

Possible Nursing Diagnoses:

1. Fluid Volume Excess secondary to disease process
2. Pain secondary to abdominal paracentesis

Materials:
Antiseptic swab, Fenestrated drape, Lidocaine 15, 5-mL ampule, Syringe, 10 mL;2-inch-long
injection needle, No.11 blade scalpel; 14-gauge catheter over 17-gauge x 6-inch needle with three-way
stopcock or one-way valve, self-sealing valve, and a 5-Ml Luer Lock syringe; Drainage Bag or vacuum
container; tubing set with roller clamp; adhesive dressing; gauze, 4 inch x 4 inch

B. Directions: Provide your assessment findings/rationale on the box. You are rated based on the
performance rubrics.
PROCEDURE RATIONALE

1. Identify the purpose for the This allows the nurse to anticipate effects of the
abdominal paracentesis. abdominal paracentesis and to observe client’s
response.

2. Check allergies to medications or This will decrease the chance of complication during
anesthetic, bleeding problems, the abdominal paracentesis.
medications currently using,
including aspirin, or if the client
might be pregnant

3. Assess client’s knowledge Determines the need for education and assists in
regarding the abdominal identifying questions and concerns.
paracentesis.

4. Assess the client for bleeding Patients with bleeding disorders are at risk of
tendencies perioperative bleeding.

5. Wash hands Reduces the transmission of microorganisms.

6. Ask the client if he has ever had
the procedure done before. Tell the
client that the procedure is
usually not painful.
Paracentesis is an invasive procedure, hence clients
are at increased risk for infection, especially
perotinitis. This allows for conversation to explain the
procedure, what to expect and to clarify questions the
client may have.

7. Check the physician’s or By understanding the reasons, the nurse can better
qualified practitioner’s order for clarify procedure for clients. This also allows the
 the reason for the test and clarify
diagnosis.
8. Verify that a consent form has
been signed by the client.
9. Assess the client’s allergic status
to local anesthetics or antiseptic
solutions
10. Ask the client to void as
completely as possible.
11. Measure the client’s abdominal
girth and weight.
12. Help the client to assume a fully
supported upright position in the
bed or chair, if possible. If the
client can sit in a chair,support
his or her feet.
13. Wash your hands again.
14. Assemble equipment. Open the
sterile abdominal paracentesis
tray using sterile technique, if
requested by the person
performing the procedure.
15. Place a blood pressure cuff on
one of the client’s arms
16. Record the client’s blood
pressure readings and pulse rate
at 15-minute intervals and
observe the client for signs of
pallor or sweating.
17. When the procedure is
completed, assist the client to
assume a comfortable position.
18. Obtain measurements of the
client’s abdominal girth and
weight
nurse to have available the correct collection
container. If the procedure is for a cell count, a test
tube for a small amount of fluid will be needed to
send a specimen to the laboratory.
This is a surgical procedure and hence requires that
the client understand the potential associated risks.
The consent also protects the hospital, client,
physician or qualified practitioner, and nurse legally.
Protects the client from an avoidable allergic reaction.
Decreases the potential of inadvertently piercing the
client’s bladder. If urination is not possible,
catheterization will be necessary.
Allows for assessment of the amount of fluid removed
and serves as a comparison if fluid reaccumulates.
In a sitting position,the client’s intestines will float
away from the paracentesis site and the danger of
punctured intestines will be lessened.
Decreases the transmission of microorganisms.
Maintains sterile procedure.
Allows you to assess the client’s blood pressure
continuously since the removal of excessive fluid or
removal that is too fast can cause a decrease in blood
pressure and potentially shock.
Indicates if the client is experiencing vascular
collapse.
Enables the client to relax after the procedure.
Serves as a comparison with the preparacentesis.
 19. Monitor the client’s vital signs, Monitors the client for complications of shock or
urine output, and dressing hemorrhage.
drainage or bleeding every 15
minutes 4 times or as ordered.

20. Label the fluid specimen, place If the fluid is for culture and sensitivity, overgrowth of
in biohazard bag, and send it to microorganisms will occur if the fluid is allowed to
the laboratory as soon as sit. Label identifies specimen. Bag protects you from
possible. contact with body fluids.

21. Record and describe the amount Communicates the findings to the other members of
of fluid drained. Describe the health care team and contributes to the legal
consistency, color, and opacity of record by documenting the care given to the client.
the fluid

22. Dispose of equipment according Decreases the transmission of microorganisms.

to your agency guidelines.

23. Wash hands. Reduces the transmission of microorganisms.

24. Assess client’s response Based on the results, further medical intervention
regarding the treatment. may be necessary.

Reference: (Kozier, Erb, Berman, & Snyder, 2014)

C. Write medical terms and abbreviations related to this procedure. Provide meaning for each.

Abdomen - (commonly called the belly) is the body space between the thorax (chest) and pelvis.
Abdominal Paracentesis - is a sterile procedure in which a needle is inserted through the
abdominal wall to obtain a sample of any fluid that is present or to drain a larger
volume of fluid to relieve pressure.

Abdominal Girth - is the measurement of the distance around the abdomen at a specific point.
Measurement is most often made at the level of the belly button (navel)

Ascites - is the abnormal build-up of fluid in the abdomen