Paracentesis/Peritoneal Lavage




Indications



Listen






  • • Diagnostic sampling of ascitic fluid (eg, internal bleeding following blunt abdominal trauma, chylous ascites after surgery, rule out malignancy, identification of infectious organism in spontaneous bacterial peritonitis).


    • Therapeutic removal of the ascitic fluid (eg, chylous ascites, tense ascites, intestinal lymphangiectasia).





Contraindications



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Absolute





  • • Unstable airway.


    • Hemodynamically unstable patient.


    • Intestinal perforation.





Relative





  • • Infection of the abdominal wall.


    • Coagulopathy (prothrombin time > 18 seconds).


    • Thrombocytopenia (platelet count < 100,000/mcL).


    • Recent intestinal tract surgery (< 1 month ago).





Equipment



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  • • Alcohol swabs, povidone-iodine.


    • 23-gauge and 21-gauge needles or angiocatheters with syringes.


    • Local anesthetic (eg, 1% lidocaine).


    • Large bore needle with plastic catheter.


    • Sterile containers for fluid collection.


    • Appropriate culture tubes for microorganisms.





Risks



Listen






  • • Pneumoperitoneum.


    • Perforation: Intestine, solid organs.


    • Bleeding.


    • Infection.





Patient Preparation



Listen






  • • Explain indication and risks to the patient and parents.


    • Inform the patient of the intention of the procedure.





Patient Positioning



Listen






  • • Supine or side.



Jan 4, 2019 | Posted by in PEDIATRICS | Comments Off on Paracentesis/Peritoneal Lavage

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