CLINICAL PRESENTATION ON ADVANCED NURSING PRACTICE: CLINICAL PRESENTATION ON ADVANCED NURSING PRACTICE TOPIC: ABDOMINAL PARACENTESIS PRESENTED BY : MR. MAHENDRA BIRADAR GOAL: GOAL To give the brief knowledge useful for implementing at clinical. Topics to be covered: Topics to be covered Introduction Definition Purpose Reasons of ascites Equipments Position Sites Nursing Interventions Special considerations Complications INTRODUCTION: INTRODUCTION A bed side presentation, abdominal paracentesis involves the aspiration of the fluid from the peritoneal space through a needle, trocar or cannula inserted in the abdominal wall . The procedure must be performed cautiously in pregnant patient and in those with bleeding tendencies or unstable vital signs DEFINITION: DEFINITION The aspiration of fluid from peritoneal cavity. PURPOSE: PURPOSE To obtain the specimen of peritoneal fluid for bacteriological/cytological examinations. To administer drugs e.g. cytotoxic drugs. To relieve abdominal pressure in ascites. REASONS OF ASCITES: REASONS OF ASCITES Liver Diseases(cirrhosis of liver) Infections(peritonitis) Cancer( Meig’s syndrome) Kidneydiseases ( nephrotic syndrome) Heart failure Slide 8: EQUIPMENTS Scalpel, No. 11 blade Catheter, 8F, over 18 ga x 7 1/2" needle with 3-way stopcock, self-sealing valve, and a 5-mL Luer -Lock syringe Measure tape Sterile gloves Gown Goggles Linen Four vacutainer laboratory tubes Two large glass vacutainer bottles (1000 ml or larger) Dry,sterile pressure dressing Slide 9: Laboratory request forms Povidone -iodine solution Local anesthetic (multi dose vial of 1% or 2% lidocaine with epinephrine) 4” * 4” sterile gauze pads Sterile paracentesis tray ( containing needle,trocar,cannula,three way stopcock) Disposable sterile drapes Marking pen 5 ml syringe with 22 G or 25 G needle POSITION: POSITION SITES: SITES NURSING INTERVENTIONS: NURSING INTERVENTIONS Pre-procedure: Check for signed consent form. Prepare the patient by providing the necessary information and instructions and by offering reassurance. Instruct the patient to void. Gather appropriate sterile equipments and collection receptacles. Place the patient in upright position on the edge of the bed or in a chair with feet supported on a stool. Fowlers position should be used by the patient confined to bed. Place the sphygmomanometer cuff around patients arm Continued……..: Continued…….. Procedure: The physician using aseptic technique inserts the trocar through a puncture below the umbilicus. The trocar or needle is connected to the drainage tube, the end of which is inserted in to a collecting receptable . Help the patient maintain position throughout the procedure. When the procedure ends and the doctor removes the needle or trocar and cannula , he may suture the incision. Wearing sterile gloves apply the dry, sterile pressure dressing and povidone -iodine ointment to the site. Help the patient assume a comfortable position. Slide 14: 1.Apply antiseptic solution 2.Draping 3.Local anesthesia 4.Deep anesthesia 5.Skin nick 6.Insertion of needle Slide 15: 7.Aspiration of fluid 8.Stabilisation of needle & syringe 9.Advance catheter 10.Sample collection 11.Collecting tube 12.bottle Slide 16: Post-Procedure Return the patient to bed or to a comfortable sitting position. Measure, describe and record the fluid collected. Label samples of fluid and send to laboratory. Monitor vital signs every 15 min for 1 hr, every hr for 2 hr, and then every 4 hr. Measure the patient’s temperature. Assess for hypovolemia , electrolyte shifts changes in mental status, and encephalopathy. When taking vital signs, check puncture site for leakage or bleeding. Provide patient teaching regarding need to monitor for bleeding or excessive drainage from puncture site, importance of avoiding heavy lifting or straining, the need to change position slowly, and frequency of monitoring for fever. SPECIAL CONSIDERATIONS: SPECIAL CONSIDERATIONS Try to help the patient remain still to prevent accidental perforation of abdomen. Reduce the vertical distance between cannula and drainage collecting container to slow the drainage rate, if the patient shows signs of hypovolemic shock. Fluid aspiration limit 1500-2000ml COMPLICATIONS: COMPLICATIONS Hypotension Oliguria hyponatremia Slide 19: DOCUMENTATION Record the date and time of the procedure, the puncture site location and whether the wound was sutured. Document the amount of colour , viscosity and odour of aspirated fluid in your notes and in the fluid intake and output record. Record the patients vital signs, weight & abdominal girth measurement before and after the procedure. Note the patients tolerance of the procedure vital signs and any signs and symptoms of complication during the procedure. Document the number of specimens sent to the laboratory.