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The Ascitic Tap
Abdominal paracentesis, also known as the ascitic tap, is a medical procedure used to either diagnose or treat ascites.
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Equipment & Preparation
- 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
Procedure
- 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
Complications
Read More...
Ennis J, Schultz G, Perera P, Williams S, Gharahbaghian L, Mandavia D. Ultrasound for detection of ascites and for guidance of the paracentesis procedure: technique and review of the literature. International Journal of Clinical Medicine. 2014 Nov 4;5(20):1277.Grabau CM, Crago SF, Hoff LK, Simon JA, Melton CA, Ott BJ, Kamath PS. Performance standards for therapeutic abdominal paracentesis. Hepatology. 2004 Aug 1;40(2):484-8.Runyon BA. Paracentesis of ascitic fluid: a safe procedure. Archives of internal medicine. 1986 Nov 1;146(11):2259-61.De Gottardi A, Thévenot T, Spahr L, Morard I, BressonHadni S, Torres F, Giostra E, Hadengue A. Risk of complications after abdominal paracentesis in cirrhotic patients: a prospective study. Clinical Gastroenterology and Hepatology. 2009 Aug 31;7(8):906-9.Webster ST, Brown KL, Lucey MR, Nostrant TT. Hemorrhagic complications of large volume abdominal paracentesis. American Journal of Gastroenterology. 1996 Feb 1;91(2):366-8.