Morning Report: 10/31/13

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:

  1. 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
  2. Insert the needle with your dominant hand
  3. Avoid the use of a needle with a plastic catheter or sheath
  4. Remove the needle in one rapid, smooth movement when finished

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Management of persistent fluid leak:

  1. Place ostomy bag over the leak site
  2. Place figure of 8 stitch over the site
  3. 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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