WOMEN AND NEWBORN HEALTH SERVICE
King Edward Memorial Hospital
CLINICAL GUIDELINES
GYNAECOLOGY GUIDELINES
NURSING CARE
ABDOMINAL PARACENTESIS
AIM
•
To aspirate and drain abdominal contents for therapeutic/diagnostic reasons or comfort.
KEY POINTS
1.
Abdominal paracentesis involves the removal of excess abdominal fluid (ascites) that has
1
accumulated within the abdominal cavity.
The patient must have venous access and coagulation profile blood results available prior to the
2
commencement of the procedure.
1
Possible complications include secondary peritonitis, pulmonary emboli and hypotension. The
2
woman can have hypotension or decreased urinary output up to 6 days after the procedure.
1
Contraindications include intravascular coagulopathy and fibrinolysis.
It is recommended that all ascitic fluid should be drained to dryness in a single session as rapidly
as possible over 1-4 hours. It should be aided by gentle mobilization of the cannula or turning the
1
patient on their side if necessary.However there is no consensus on fluid withdrawal speed.
With oncology patients(malignant ascites)the rate of drainage must be documented in the medical
notes by the medical officer.
The procedure is frequently done under ultrasound guidance.
2.
3.
4.
5.
6.
7.
EQUIPMENT
•
Sterile chest aspiration tray
Add to trolley:
Sterile equipment
•
1 x 2ml syringe; 1 x 5ml syringe; 1 x 10ml syringe
•
25g needles; 19g needles; 19g drawing up needles
•
Sterile gloves and sterile gown
•
•
PPE: face shield / glasses
Drain site dressing – (Soft-wick split dressing)
•
Specimen jars
•
Argyle Trocar and Catheter size 16g and 20g x 2
•
Paracentesis/thoracentesis kit 3.8cm
•
Gauze dressing x 2
•
2 x occlusive dressing e.g. Tegaderm
•
Scalpel blade No.11
•
3/0 silk suture material – needled
•
Lignocaine 1% local anaesthetic
• Fenestrated drape
Non Sterile
• Continence sheet
DPMS
Ref:8346
All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual
Page 1 of 3
•
Tape, Fixomull
•
Tubing clamp
•
Measuring jug
•
Antiseptic skin preparation (Chlorhexidine 2% in 70% alcohol)
PROCEDURE
1.
ADDITIONAL INFORMATION
3
Prepare:
• Explain the procedure to the woman &
ensure that informed consent is
1, 3
given.
• Check blood results.
3
• Identify correct patient by 3 indicators
2
(e.g. name, DOB, address, UMRN).
Helps to clarify questions , ease anxiety and
promote cooperation. Educate on the risks,
purpose, positioning, symptoms & to inform
staff if any concerns/ symptoms/
3
complications.
Venous access and coagulation profile blood
results should be available prior to
2
procedure.
2, 3
Minimises the risk of bladder perforation.
2.
Ensure the woman has recently emptied her
2, 3
bladder prior to the procedure.
3.
Position the woman as directed by the
Medical Officer.
4.
Perform baseline observations.
5.
Wash and dry hands, open the sterile pack
and place the sterile equipment on the
sterile fields. Assist the Medical Officer to
gown and glove. Check the local
anaesthetic with the Medical Officer and
pour the solutions.
Maintain a sterile area.
6.
The Medical Officer will clean the abdomen,
insert the local anaesthetic, then the Trocar
and cannula, and obtain a fluid specimen if
necessary. A suture may or may not be
inserted.
Ultrasound guided paracentesis has been
1
found to be more effective than non-guided.
7.
Observe the woman throughout the insertion
2, 3
procedure.
Assess blood pressure regularly & report any
hypotension, pallor, cyanosis or faintness to
the Medical Officer immediately.
8.
Apply the split dressing to the drain and
anchor the dressing firmly to the abdominal
wall.
Dressings and connections should be
2
adhered securely.
9.
Connect the tube to the drainage bag as
requested.
Drainage should be uninterrupted, unless
2
otherwise instructed by the Medical Officer.
10.
Ensure the woman’s comfort.
Reposition the woman and offer analgesia,
2
she should remain in bed during drainage .
2
The head of the bed should be raised around
1
30-40 degrees. In a sitting position there is
less risk of intestinal damage as the intestines
3
move away from the paracentesis site.
2
Include patient’s weight and abdominal girth,
as requested, for comparison if fluid re3
accumulates.
3
3
PROCEDURE
11.
12.
13.
14.
Monitor and record pulse and blood
pressure half hourly for 1 hour, then hourly
2
until discharge or drainage is complete.
Observe closely for signs of:
a) haemorrhage
b) shock
c) observe and record the colour of the
drainage e.g. clear, cloudy, blood
stained
Monitor dressing and record fluid output on
2
fluid balance chart. (Every 15/60 – 1/24,
30/60 – 2/24, hourly for 4/24).
Label any specimens and send to
3
laboratory.
When the procedure is completed, the
medical officer may remove the peritoneal
drain and a dressing is then applied or the
tubing may remain on intermittent straight
drainage as ordered.
ADDITIONAL INFORMATION
Can denote perforation of blood vessel.
If draining for an extended period (days) –
ascertain the frequency of observations from
the Medical Officer.
Observe the puncture site, document and
2
report any leaking to the medical officer. If
fluid stops draining, reposition on her side, if
2
unsuccessful contact the Medical Officer.
Send as soon as possible.
3
On removal, apply a sterile dressing and
2
occlusive secondary dressing.
For hepatology patients, recommendation:
limit drainage time to 4 - 6 hours & for every
3L drained, replace with 100ml 20% albumin
2
(infused over an hour).
3
15.
Decontaminate and/or dispose of equipment
3
as necessary & wash hands.
Reduces microorganism transmission risk
16.
Document dressing details and fluid
3
removed.
Include the date, time, site of puncture, any
specimen samples taken, woman’s response /
complications, vital signs, urinary output &
3
abdominal girth.
17.
Post operative care: Record the woman’s
weight, assist first ambulation, document
any further fluid drainage, and provide
2
education.
Risk of post-procedure postural hypotension
and falls. Educate the woman on the signs
and symptoms, and what to do if develops,
secondary peritonitis, haematuria, and post
paracentesis circulatory dysfunction, which
2
may occur up to 6 days.
REFERENCES ( STANDARDS)
1.
2.
3.
Sachs B. Evidence summary: Abdominal paracentesis: Clinician information. 2013. In: Acute Care Practice Manual
[Internet]. The Joanna Briggs Institute.
Sir Charles Gairdner Hospital. Nursing practice guidelines: Practice guideline No. 50: Abdominal paracentesis: SCGH.
2013. Available from: http://chips.qe2.health.wa.gov.au/NPG/pdf/Abdominal%20paracentesis%20(50).pdf
Altman G. Fundamental & advanced nursing skills. 3rd ed. Clifton Park, New York: Delmar; 2010.
National Standards – 1.2 Care provided by the clinical workforce is guided by current best practice.
Legislation - Occupational Safety and Health Act 1984, Occupational Safety and Health Regulations 1996
Standards –
Related Policies – WNHS Infection Control Manual
Other related documents – Nil
RESPONSIBILITY
Policy Sponsor
Nursing & Midwifery Director OGCCU
Initial Endorsement
May 2002
Last Reviewed
March 2014
Last Amended
Review date
March 2017
Do not keep printed versions of guidelines as currency of information cannot be guaranteed.
Access the current version from the WNHS website