Paracentesis abdominis is an invasive bedside or theater procedure where a sterile needle or catheter is introduced into the peritoneal cavity to withdraw ascetic fluid. This procedure serves both diagnostic purposes to identify the cause of new-onset ascites or spontaneous bacterial peritonitis, and therapeutic goals to relieve severe abdominal pressure and respiratory distress caused by massive fluid accumulation.
The clinical situations requiring fluid removal are distinct. Diagnostic paracentesis is indicated for any patient presenting with new-onset ascites of unknown origin or suspected infection. Therapeutic paracentesis is indicated when tense ascites causes pain, early satiety, or compromises lung expansion. The main goal is symptom relief and diagnostic clarity without inducing hemodynamic instability.
Nurses must review coagulation profiles, specifically platelet counts and International Normalized Ratio (INR), before the procedure begins to minimize bleeding risks.
Preparation involves obtaining informed consent, explaining the steps to reduce anxiety, and instructing the patient to empty their bladder immediately before the procedure to prevent accidental puncture. Baseline vital signs and abdominal girth measurements are documented. Positioning the patient in a semi-Fowler's position or sitting upright allows fluid to pool dependently in the lower abdomen.
Gathering the correct equipment ensures a smooth procedure. Essential items include a paracentesis tray, local anesthetic, antiseptic solution, collection bags or vacuum bottles, specimen tubes, and sterile gloves. Strict aseptic technique is maintained throughout preparation and draping to prevent introduction of pathogens into the sterile peritoneal cavity.
During the procedure, the nurse supports the patient, monitors vital signs every fifteen minutes, and observes for signs of circulatory collapse or vasovagal episodes. Rapid fluid removal can cause sudden shifts in intravascular volume, leading to hypotension. The nurse watches for dizziness, pallor, sweating, or shortness of breath, and communicates any changes to the doctor immediately.
Following needle removal, apply a sterile dressing and monitor the puncture site for persistent leakage or bleeding. Record the total volume, color, and clarity of the fluid drained, along with post-procedure vital signs. Label collected specimen tubes correctly and send them to the laboratory promptly for cell count, gram stain, and culture.
Complications can arise despite careful technique. Persistent fluid leakage from the puncture site, localized hematoma, bowel perforation, and hypovolemic shock are primary concerns. Nurses must inspect the dressing frequently, monitor for severe abdominal pain or rebound tenderness indicating peritonitis, and report signs of shock immediately to initiate fluid resuscitation or albumin replacement.