Tuesday, November 3, 2020

Ascitic Tap

Written informed consent, Betadine, Spirit, Sterile gloves, Sterile drapes, a 1.5-3.5 cm 20-22 G needle, a 5-20mL syringe is used, 18-20 G needle attached to a non-collapsible tube (can be made by breaking drip chamber of an IV set and putting one end of it in an empty water bottle for therapeutic tap tubing to a sterile collection bag)

1. Follow universal precautions. 

2. Skin around the site of puncture to be disinfected with betadine or Chlorhexidine and spirit and draped with sterile drapes.

3. Position: The patient should be in supine position( can be asked to roll slightly to left)

4. Site: a) At the junction of medial two-third and lateral one-third of the line join umbilicus and left Anterior superior iliac spine (left side is preferred over right to avoid damage to caecum)
b) 4 inches above iliac crest, whichever is more dependent

Site has to be lateral to rectus muscle. Avoid areas of scar.

5. Local Anaesthesia:
a) Skin, subcutaneous tissue, abdominal wall layers up to parietal peritoneum to be anesthetized with 2% lidocaine filled syringe using a 22-25 G needle.The needle is advanced into the subcutaneous tissue aspirating every 2-3 mm prior to injecting. 
b) Once a loss of resistance is felt and peritoneal fluid is drawn into the syringe, it indicates that we have entered the peritoneal cavity. Additional lidocaine is then injected to anesthetize the pain-sensitive parietal 
(A total of approx. 4-5 ml lidocaine is adequate.) 
c) The needle is then withdrawn. 

6. Puncture: 
For diagnostic tap – a 1.5-3.5 cm 20-22 G needle attached to a 5-20mL syringe 
is used. 
Technique – The aim is to prevent leak by ensuring the skin puncture site is 
not directly over the puncture site into the peritoneal cavity. 
 Z track technique – Pull skin about 2 cm downward before puncturing 
skin→ then leave the skin after entering few mm so as to form a Z
prick the skin, go for some distance in the subcutaneous plane and then change the angle to vertically downwards to enter the peritoneal cavity.  

For therapeutic tap - A large bore 1.5-2 cm 16-18 G needle is used instead.The syringe is detached and the needle is attached to a non-collapsible rubber tubing.The ascites fluid is drained slowly through the rubber tubing connected to the needle into a sterile collection bag. 

7. Seal : After the puncture, the punctured skin is sealed with a tincture benzoin 

8. Post procedures: T.P.R, B.P to be recorded half hourly and the 
patient should not be given feeds for the next 4 hours. If there is pain, analgesics may be given.

- Mitali shroff

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