The Ascitic Tap

Apron

Nonsterile Gloves

Sterile Gloves

Ultrasound Machine

Skin Marking Pen

Decontaminant

Chlorhexidine or povidone-iodine

Sterile Field

With plenty of sterile gauze

Fenestrated drape

Syringes

Local Anaesthetic

1% lignocaine in a 5mL syringe

Ascitic Tap Needle

Simple needle (diagnostic) or cannula (therapeutic)

Dressing

Small island dressing

Exit Strategy

Sharps disposal bin close by

Specimen Containers

Documentation

Lab request form, patient labels

Explain the procedure and ask for patient's consent

Ensure that the patient has emptied their bladder

Positioning

Patient supine with abdomen exposed

Identify the Site

Left lower quadrant

Using ultrasound to identify an area of maximum fluid

Mark the Insertion Site

Using skin marking pen

Prepare Sterile Field

Open all required sterile equipment onto field

Prepare the Site

Decontaminate a large area with chlorhexidine or iodine

Scrub and don sterile gloves

Apply the fenestrated drape

Prepare Equipment

Place everything in the order it will be used

Stretch the skin taut (Z-tracking)

Inject Local Anaesthetic

Create a small wheal over the site then inject through the whole insertion tract

Insert the Needle / Cannula

Through the marked site, until flashback of ascitic fluid

Remove the needle from the cannula if performing an ascitic tap

Release the skin (Z-tracking)

Take Diagnostic Sample

25 - 50mL depending on desired tests

Assistant to fill specimen containers

Therapeutic Tap

If indicated

Remove large volumes using collection system

Remove the Needle / Cannula

Place the Dressing

Clean Up

Dispose of sharps and other waste

Remove gloves and wash hands

Processing

Label the collection tubes and send to the lab

Ascitic Fluid Leak

From Insertion site

Bleeding

From insertion site or into abdomen

Visceral Perforation

Bladder or bowel