Paracentesis

Abdominis

Prepared by: Nakadumrongchai,Kamollaphu

Paracentesis -a.k.a (Peritoneal tap )

- is a minor surgical procedure where the

abdominal cavity is punctured in order to
aspirate and examine the fluid contained
therein.
INDICATIONS

 Find the cause of fluid buildup in the belly.

 Diagnose an infection in the peritoneal fluid.
 Check for certain types of cancer or metastasis on visceral
organs, (ie., liver,pancreas)
 Relieving abdominal pressure through evacuation of ascitic
fluid that is causing pain or difficulty breathing or that is
affecting  kidneys or the intestines (bowel) functioning
 Check for damage after a belly injury. (hemorrhage
CONTRAINDICATIONS

 acute abdomen that requires surgery. (absolute)

Relative contraindications

 Pregnancy
 Distended urinary bladder
 Abdominal wall cellulitis
 Distended bowel
 Intra-abdominal adhesions.
 
PRECAUTIONARY MEASURES
Ask the patient if he or she is
- allergic to any medicines, including numbing
medicines (anesthetics).
- Have had bleeding problems or taking blood thinners,
such as aspirin,or warfarin (Coumadin).
- for females if pregnant
 Other blood tests may be done before a paracentesis to
make sure that the patient does not have any bleeding
or clotting problems.
 Have the patient empty her bladder prior to initiation of
the procedure.
TECHNIQUE

 1. The abdomen is prepared using antiseptic (povidone

iodine) while the patient is in supine position.

 2. The preferred location of the abdominal tap is

chosen. Both the four quadrant peritoneal tap and
bilateral flank tap are equally reliable.

 3. an 18 – gauge short bevel spinal needle is attached to

a syringe and inserted through the abdominal wall with
1% xylocaine.
 4. Continuous suction is applied to the syringe as the
needle is slowly advanced into the abdomen until a feeling of “give” is
appreciated.

5. return of a minimum of 0.1 ml of non-clotting blood is

considered a positive tap.
OTHER TECHNICAL CONSIDERATIONS

1.Puncture of the rectus abdominis sheath anteriorly should be avoided.

2. Areas of the abdominal scars or other points of possible bowel fixation

to the abdominal wall should be avoided.

3. The point of the needle should be superficial to the peritonium when

redirecting it and reintroducing it into the peritoneal cavity.

4. Peritoneal taps shoud be avoided in the presence of markedly dilated

bowel.
POSSIBLE COMPLICATIONS

- Injury to the abdominal viscera ,bleeding

- introduction of infection

- Drawback and limitations

- High Percentage of false negative result