Introduction

This procedure is the insertion of a drain into or aspiration of the peritoneal cavity.Drains can be inserted into the peritoneum in a trauma situation (diagnostic peritoneal lavage) and to manage renal failure (continuous ambulatory peritoneal dialysis). These will not be discussed here.

Indications

The indications for abdominal paracentesis are:

Therapeutic drainage of intra-abdominal fluid:

1. ▪ Relief of abdominal distension

2. ▪ Relief of pain

3. ▪ Respiratory compromise.

Diagnostics on peritoneal fluid:

1. ▪ Bacteriology

2. ▪ Chemical pathology – protein content

3. ▪ Cytology – suspected malignancy.

Contraindications

1. ▪ Severely scarred abdomen

2. ▪ Coagulopathy

3. ▪ Bowel obstruction

4. ▪ Pregnancy

5. ▪ Infected skin at insertion site.

Equipment

1. ▪ Either use a purpose-designed paracentesis set, or a Bonanno supra-pubic catheterization set can be used.

2. ▪ Drainage bag.

3. ▪ Sterile preparation.

4. ▪ Local anaesthetic.

5. ▪ Suture material.

6. ▪ Syringes and bottles for taking samples.

Technique

1. ▪ The patient is placed in a supine position.

2. ▪ The fluid/air interface is percussed out.

3. ▪ The site is marked with a pen. Preferred sites of entry are shown in Figure 141. These are either of the lower quadrants (lateral to the rectus muscle), or below the umbilicus. Paracentesis site should not be at a site of prior incision and must not be infected.

4. ▪ The patient is prepared and draped.

5. ▪ The anaesthetic is injected into the skin and infiltrated down into the abdominal wall.

6. ▪ Sampling: a 14-gauge needle with a syringe can be used to obtain peritoneal fluid.

7. ▪ Therapeutic drainage: a Bonanno catheter, CVP catheter or peritoneal dialysis catheter are inserted using a stylette or a Seldinger technique.

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