GARCES, SHERLYN M.

FEBRUARY 23, 2023

BSN 3-B GROUP 10
NCM 116 RLE

CARE BEFORE, DURING, AND AFTER PARACENTESIS

Paracentesis is a procedure to obtain small sample or drain ascetic fluid from the
peritoneal cavity using a needle or catheter for either diagnostic or therapeutic purposes. It is
done in a lateral or supine position wherein ascites fluid level is percussed and a needle or
catheter is inserted either in midline or lateral lower quadrant. Development of fluid in the
peritoneal spaces can occur as a result of many factors. Thus, performing paracentesis will help
determine the etiology of the patient’s ascites. Moreover, draining peritoneal fluid can help
identify infection, causes of liver or portal hypertension and also relieve the symptoms by
removing large volume of fluid.
Before the procedure, ask patient about medicines he/she is taking, and for any
allergies. Moreover, equipment are prepared and so is the patient. As a nurse, we first ask the
client to empty his bladder before starting the procedure to prevent injury to the bladder during
the procedure. In other cases, a foley catheter may be placed into the bladder to drain urine.
The nurse will position the client in supine, drape the patient in a sterile manner, and prep the
patient. The nurse will first clean the umbilicus then the skin of the planned site of insertion with
an antiseptic solution three times in a circular motion from inner to outer. During the procedure,
the nurse will assist the doctor. The doctor then will administer local anaesthesia such as
Lidocaine to the skin and soft tissue at the planned site of needle insertion. After that a needle or
IV catheter attached to a syringe or pre-packaged catheter directly perpendicular to the skin or
using the ztrack method to decrease the chance of fluid leakage after the procedure using a
ultrasound to guide the procedure. After insertion the needle, a sample of fluid is collected using
three specimen container and will be sent to the laboratory for analysis. The needle is then
secured to prevent pulling out of needle from the abdomen. The length of procedure varies for
each person, but in most cases it takes about 30 minutes. Once the fluid is drained, the needle
and will will be removed and pressure is applied on the punctured site to stop any fluid leakage
or bleeding. Then, a dressing will be placed over the puncture site and albumin may be given
during or after the procedure to prevent hypotension or kidney problems. After the procedure,
the patient will be moved to recovery room and will be monitored. If client complains of pain,
medication will be given as prescribed. Educate patient that it is normal to have small amount of
fluid leakage from the puncture site. However, if fluid is still leaking from puncture site for a day
after the procedure, immediately visit the doctor. In addition, instruct the patient to keep the
dressing or bandage for at least 24 hours and advice patient that he/she can shower 24 hours
after the procedure. Advise patient to take off the bandage and wash the puncture site then
place a new, and clean bandage over the area. Educate client that he/she can go back to
normal activities, unless doctor give other instructions. Moreover, it is important to education
client to observe for symptoms such as redness at puncture site, increased pain in abdomen,
fever, chills, dyspnea, and increased amount of fluid leaking from puncture site. This may be a
sign of infection or problem internally, thus, it is important to call physician immediately.
The role of the nurse in paracentesis is to monitor the patient throughout the procedure,
administer treatment as directed by the healthcare professionals, depending on agency policy,
and remove the drain at the end of the procedure. Knowledge of the risks of the procedure is
essential to provide safe, evidenced-based care for the patients who will be undergoing
paracentesis.

Reference/s:

About your paracentesis (abdominal tap). Memorial Sloan Kettering Cancer Center. (n.d.).
Retrieved February 23, 2023, from
https://www.mskcc.org/cancer-care/patient-education/paracentesis-abdominal-
tap#:~:text=Keep%20your%20bandage%20on%20for,still%20leaking%20from%20the
%20site.

Paracentesis - StatPearls - NCBI Bookshelf. (n.d.). Retrieved February 23, 2023, from
https://www.ncbi.nlm.nih.gov/books/NBK435998/