Ascitic Taps

Ascitic Fluid Analysis

How to interpret ascitic fluid testing
Indications

Diagnosis of ascites or suspected SBP; therapeutic tap for relief of tense ascites
Contraindications

Coagulopathy, bowel obstruction, full bladder

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

Ascitic Fluid Leak

From Insertion site
Bleeding

From insertion site or into abdomen
Visceral Perforation

Bladder or bowel

Indications

On this page:Indications for Ascitic Tap

Indications for Ascitic Tap

Diagnostic tap - for investigation of new-onset ascites, or for investigation of suspected spontaneous bacterial peritonitis (SBP)
Therapeutic tap - for symptomatic relief of ascites in haemdynamically stable patients

Last updated on April 22nd, 2019

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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.

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Ascitic Fluid Analysis

Indications

Contraindications

Nonsterile Gloves

Sterile Gloves

Ultrasound Machine

Skin Marking Pen

Decontaminant

Sterile Field

Syringes

Local Anaesthetic

Ascitic Tap Needle

Dressing

Exit Strategy

Specimen Containers

Documentation

Positioning

Identify the Site

Mark the Insertion Site

Prepare Sterile Field

Prepare the Site

Prepare Equipment

Inject Local Anaesthetic

Insert the Needle / Cannula

Take Diagnostic Sample

Therapeutic Tap

Remove the Needle / Cannula

Place the Dressing

Clean Up

Processing

Ascitic Fluid Leak

Bleeding

Visceral Perforation

Indications

Indications for Ascitic Tap

Read More...

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