11/13/24, 7\:18 PM Guide | Ascitic drain

Ascitic drain

Table of contents

Introduction

An ascitic drain (therapeutic paracentesis) involves removing excessive ascitic
This is a therapeutic procedure, however, a sample of ascitic ascitic
analysis.
When draining ascitic
of ascitic

Gather equipment

Gather the appropriate equipment to perform an ascitic tap\:
Sterile gloves
Apron
Dressings pack
Sterile surface (nursing trolley which has been appropriately cleaned)
Ascitic drain pack (e.g. Bonanno)
20ml syringe
Sharps container
Chlorhexidine swab (ChloraPrep™)
Urinary catheter bag and stand
2x cannula dressings
20% human albumin solution (HAS)
Scalpel blade
Local anaesthetic\: lidocaine 1% or 2%, drawing-up needle, orange needle (25G), green needle (19G), 2oml syringe
Specimen container (usually a white top specimen pot)\: if sending

Ultrasound (if available)

Ideally, ultrasound is used to con
possible to perform this procedure without ultrasound.

Introduction

Wash your hands using alcohol gel. If your hands are visibly soiled, wash them with soap and water.
Don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Explain what the procedure will involve using patient-friendly language\:
“ I n e e d t o i n s e r t a n a s c i t i c d r a i n i n t o y o u r a b d o m e n .
T h e p u r p o s e o f t h i s p r o c e d u r e i s t o r e d u c e t h e
n e e d l e i n t o y o u r a b d o m e n a n d t h e n a d r a i n . T h i s d r a i n w i l l b e t h e r e f o r a f e w h o u r s . I t c a n b e p a i n f u l w h e n t h e n e e d l e i s
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i n s e r t e d s o w e a r e g o i n g t o u s e a l o c a l a n a e s t h e t i c . T h e r e a r e a f e w r i s k s a s s o c i a t e d w i t h t h i s p r o c e d u r e . T h e s e r i s k s i n c l u d e
b l e e d i n g , p a i n , i n f e c t i o n , d a m a g e t o s u r r o u n d i n g o r g a n s a n d
"
Gain written consent to proceed with inserting the ascitic drain.
Check if the patient has an allergy to local anaesthetic (if requested) or to the skin preparation agent.
Check for any contraindications.
Ask the patient if they have any pain before continuing with the clinical procedure.
Ascitic drain contraindications
Infection overlying the intended drain insertion site is a contraindication to inserting an ascitic drain. If an infection is
present, select another site on the patient’s abdomen to take the sample.
Other cautions (but not contraindications) include\:
Coagulopathy (INR >2.0)
Platelets \<50
Pregnancy
Organomegaly
Ascitic drain complications
Potential complications of ascitic drain insertion should be discussed with the patient and recorded on the consent form.
Complications may include\:
Bleeding
Pain
Infection
Damage to surrounding structures (speci
Kidney injury secondary to

Con

Position the patient so that they are lying
Perform an abdominal examination to con
Whilst con
where the volume of ascites is greatest whilst the patient is lying
If available\: use ultrasound to assess the location of ascites further and to
Remove equipment from its packaging and place it onto a sterile surface so that it is easily accessible during the procedure.
Ascitic drain location
An ascitic drain is usually inserted in the right or left lower quadrant of the abdomen, where the ascitic
accumulates most. Avoid inserting the drain too superiorly, due to the risk of injuring the liver or spleen.
It is important to avoid the inferior epigastric artery which runs within the rectus sheath approximately 4-8cm from the
midline.
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Avoid the inferior epigastric artery

Prepare the insertion site

Wash your hands and don sterile gloves and an apron.
Clean the insertion site and the surrounding area thoroughly using chlorhexidine solution and allow it to dry.

Insert the ascitic drain

Local anaesthetic

1. Prepare and administer lidocaine subcutaneously using an orange needle (25G) over the planned puncture site (creating a
bleb). Aspirate to ensure you are not in a blood vessel.
2. Replace the 25G orange needle with a 19G green needle.
3. Administer lidocaine deeper into the tissue, aspirating as you go until you get a

Insertion of an ascitic drain (using a Bonanno catheter)

1. Make a small incision in the patient’s skin at the intended drain insertion site (to make the insertion easier).
2. Pick up the Bonanno catheter and straighten it out using the plastic sheath.
3. Insert the needle into the Bonanno catheter then remove the plastic sheath.
4. Attach a 20ml syringe to the end of the needle.
5. Holding the needle perpendicular to the skin, insert the needle into the previously identi
abdomen.
6. Advance the needle slowly, ensuring you aspirate as you advance.
7. Once you aspirate ascitic
8. Aspirate 20ml of ascitic
9. Start to pull back the needle, whilst simultaneously advancing the Bonanno catheter (the needle will provide the stability
needed for the catheter to be inserted). The technique used here is similar to inserting an intravenous cannula.
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10. Advance the Bonanno catheter until it is at the hilt.
11. Remove the needle.
12. Secure the catheter with two cannula dressings on either side, anchoring the drain to the patient’s skin.
13. Attach Bonanno catheter to catheter bag (it should not be placed on the
14. Leave on free drainage for a maximum of six hours.
15. Ask the ward sta
volume of ascitic
Z-track technique
The Z-track technique is an alternative technique which can be used to reduce leakage of ascitic
paracentesis.
The skin is stretched approximately 2cm before inserting the needle into the epidermis. The skin is held in this position
whilst the needle is advanced. The skin is then released after the needle has been removed. This technique creates
a non-linear path between the skin and abdominal cavity.

Human albumin solution

Prescribe and administer 100ml of human albumin solution 20% (HAS) for every 2-3 litres of ascitic
need to be ordered from the hospital blood bank.

Ascitic

If the ascitic analysis, place the aspirated ascitic

To complete the procedure...

Explain to the patient that the procedure is now complete.
Thank the patient for their time.
Dispose of PPE and other clinical waste into an appropriate clinical waste bin.
Wash your hands.
Document the details of the procedure including\:
Whether local anaesthetic was used
Volume and colour of ascitic
Any immediate post-procedure concerns to complications
Prescription for human albumin solution
When the ascitic drain is removed, the total volume of ascitic
removal.
Send the ascitic samples to the lab for analysis in an appropriate plastic leak-proof bag with the completed laboratory request
form\:
Cytology
Gram staining
Microscopy, culture and sensitivity
Albumin, protein, LDH, glucose, white cell count
For more information on interpreting results, see the Geeky Medics guide to ascitic .
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Reviewers

Dr Coral Hollywood
Consultant Gastroenterologist
Dr Richard Makins
Consultant Gastroenterologist
Source\: geekymedics.com
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