Paediatrics: Abdominal paracentesis

2021-03-04 12:00 AM

This is indicated for drainage of ascites when it compromises breathing, e.g. hydrops fetalis, or for diagnostic purposes, e.g. following trauma.

Abdominal paracentesis

This is indicated for drainage of ascites when it compromises breathing, e.g. hydrops fetalis, or for diagnostic purposes, e.g. following trauma.

Equipment 

As for, Pericardiocentesis.

Procedure

  • In infants, the left iliac fossa is the preferred site (which avoids the liver and spleen). In older children, a midline site between the symphysis pubis and the umbilicus is preferred because of less vascularity.
  • Lay the child supine. If ascites is minimal also tilt towards the left side.
  • Except in emergencies, clean and prepare the site as described by Pericardiocentesis.
  • Attach the needle to the syringe and carefully insert it at 90° to the skin.
  • Aspirate fluid and place it in sample containers. If large amounts of fluid are to be drained use an IV cannula. Once inserted, remove the stylet, and leave the cannula in place to reduce the risk of bowel perforation. If prolonged drainage is needed, attach the cannula to the skin using adhesive tape or stitches.
  • Once complete, remove the needle and apply sterile plaster to the site
  • If a large amount of fluid is withdrawn, drainage should be followed by an IV infusion of albumin.