What is the indication of a paracentesis? - correct answer ascites
- new onset
- therapeutic
- diagnostic
What are the relative contraindications
... [Show More] for a paracentesis? - correct answer Coagulopathy
Overlying anatomical or infectious abnormalities
Distended abdominal organs (i.e. ileus, megacolon)
Surgical scars: May have attached bowel
T/F: using an US is the standard of care for a paracentesis? - correct answer TRUE
What is the best approach for a paracentesis? Why? - correct answer Lateral
Bc when the pt is supine, the fluid will pool to the posterior wall and avoiding bowel perforation is easier.
How should the pt be positioned for a paracentesis? - correct answer Pt supine and/or with head elevated to 10-30 degrees
(pic on lecture says 30-45 degrees)
What do you need to careful of when using the anterior approach for a paracentesis? - correct answer avoid the inferior epigastric arteries.
T/F: For a paracentesis, it is considered a complete sterile technique, when the practitioner must be gowned up as well? - correct answer FALSE- Sterile technique but do not have to fully scrub in (don't have to fully gown in)
When inserting the needle for a paracentesis, you want to pull the skin taught in what direction? - correct answer caudad (approx 1-2 cm)
How will fluid on an US appear? - correct answer anechoic/hypoechoic (DARK)
This is where the needle will go to drain!
How can you recognize and locate the bowel in an US prior to performing a paracentesis? - correct answer Bowel will glisten (more than other tissue) and you will be able to see peristalsis.
While inserting the needle for a paracentesis, how can you tell you're in the peritoneal cavity? - correct answer loss of resistance will be felt
Paracentesis procedure:
a. Hold syringe with (_) hand
b. Rest (_) surface of (_) hand on patient's abdomen, and use (_) of this hand to steady shaft of needle
c. Keep nondominant hand in this position during needle advancement and continue to hold the (_) - correct answer a. dominant
b. dorsal; nondominant; thumb and index finger
c. nondominant; shaft of needle
What type of drainage tubing is used for a paracentesis? - correct answer High-pressure drainage tubing
T/F: Want to insert the needle for a paracentesis into the wheal of the local anesthetic? - correct answer TRUE
What should always be done after you advance the needle in for a paracentesis? - correct answer aspirate- want to do that after moving the needle every time until the fluid pocket is reached.
T/F: When performing a paracentesis, you want to make sure to push the catheter all the way flush with the skin to ensure all fluid will be drained? - correct answer FALSE!
Catheter does NOT have to be flush with skin, better to keep partially out than perforate the bowel or visceral organ
What should be done after removing the catheter of the abdomen when doing a paracentesis? - correct answer apply firm, direct pressure to the site for several minutes
What types of lab samples are commonly collected during a paracentesis? - correct answer Albumin, protein: exudative vs. transudative
Cell count, differential
Gram stain, cytology
Aerobic & anaerobic cultures: blood culture
What is the most common complication of a paracentesis? How can you fix this? - correct answer Ascitic fluid leak- apply dermabond or sutures
Dermabond= best bc it provides a perfect seal.
What types of circulatory dysfunction complications can occur with a paracentesis? - correct answer Critical HYPOtension
Increased RAAS and catecholamine activity
What is the indication for a thoracentesis? - correct answer pleural effusion
Diagnostic
Therapeutic (resp distress, CHF, cirrhosis, trauma, cancer) [Show Less]