Tuesday, November 3, 2020

Ascitic Tap

Requirements
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 tubing to a sterile collection bag.

Procedure:
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.

4. Site: In the flank mid-way between the anterior superior iliac crest and 
umbilicus (lateral to rectus muscle). Areas of scars of previous surgery should be 
avoided. 

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 
peritoneum. 
(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c) The needle is then withdrawn. 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
Or
 Angular insertion technique - Insert the needle by keeping at an acute angle to the skin surface. Then advance the needle slowly through the underlying subcutaneous 
tissue in 5 mm increments while intermittently aspirating. Generally for the diagnostic purposes, the sample is sent for the following 
tests, all of them collecting in separate containers:
● Routine & microscopy
● Culture and sensitivity 
● MGIT+ Gene Xpert
● ADA
● LDH 
● Amylase
● Cytology (optional)
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 
seal. 

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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