After a small hiatus, MR is back with Dr. Reisman presenting today’s special Halloween edition! (sorry nothing really Halloween related but still good stuff!)
Abdominal Paracentesis: prevention and management of persistent ascites leak
Diagnostic paracentesis
– New onset ascites
– Patient with ascites and signs of SBP
Therapeutic paracentesis
– Removal of fluid to reduce pain or dyspnea
Elevated INR and thrombocytopenia are not contraindications
Technique to avoid ascites leak
Traditional location: 3cm above and 3cm medial to the ASIS
Or use ultrasound to find the best location
Use the Z-track technique when infiltrating lidocaine and when inserting the paracentesis needle:
- Pull the skin downward with the non-dominant hand, and continue
to put traction on the skin until the needle has entered the peritoneal cavity - Insert the needle with your dominant hand
- Avoid the use of a needle with a plastic catheter or sheath
- Remove the needle in one rapid, smooth movement when finished
Management of persistent fluid leak:
- Place ostomy bag over the leak site
- Place figure of 8 stitch over the site
- Use dermabond!
When using dermabond, use a high flow nasal cannula taped to the skin to dry the ascites fluid and allow you to apply the glue. Use multiple layers.
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD
Editor in Chief of "The Original Kings of County"
Assistant Professor of Emergency Medicine
Assistant Residency Director
SUNY Downstate / Kings County Hospital
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