Paracentesis (Peritoneal Fluid Analysis)

Norm of Paracentesis (Peritoneal Fluid Analysis)

Appearance		Clear, serous, light yellow
Amount		<50 mL
Protein		<4.1 g/dL
Glucose		70–100 mg/dL (equals serum)
Amylase		140–400 U/L (equals serum)
Ammonia		<50 mg/dL
Alkaline phosphatase
	Adult female	45–250 U/L
	Adult male	90–240 U/L
Red blood cells		Negative
White blood cells		<300/mL
Culture		Negative
Cytologic result		No malignant cells
CEA and CA 125		Negative
Fungus		Negative

 

Usage of Paracentesis (Peritoneal Fluid Analysis)

Used diagnostically to remove and examine small amounts of fluid for undiagnosed causes of abdominal effusion. May be used to instill and remove saline lavage to examine for the presence of blood if blunt trauma to the chest and abdomen is suspected.
Abnormal Appearance
Bloody: Trauma (or traumatic tap).
Turbid (cloudy): Infection, pancreatitis, intestinal perforation, and cirrhosis.
Milky: Chylous ascites.
Increased Protein
Cancer, tuberculosis, peritoneal carcinomatosis, and peritonitis.
Increased Amylase
Pancreatitis and intestinal strangulation, necrosis (intestinal), pancreatic pseudocyst, pancreatic trauma.
Increased Alkaline Phosphatase
Intestinal strangulation and ruptured intestine.
Increased Red Blood Cells
Intra-abdominal trauma, neoplasm, and tuberculosis.
Increased White Blood Cells
Infection and chylous ascites, cirrhosis, and peritonitis. Granulocyte count of >250 cells/mL is diagnostic for infection.
Increased CEA and CA 125
Malignancy. Note: An elevated CA 125 without elevation in CEA indicates primary malignancy is ovarian or endometrial.
Decreased Glucose Below Serum Level
Malignancy or TB peritonitis.

 

Description of Paracentesis (Peritoneal Fluid Analysis)

Paracentesis is the transabdominal removal of fluid from the peritoneal cavity for analysis of electrolytes, red blood cells, white blood cells, bacterial and viral cultures, and cytology studies. The procedure may be done in conjunction with endoscopic ultrasound guidance, particularly when used to reach small areas of effusion. Paracentesis may also be used therapeutically to remove ascitic fluid when the accumulation is large and disabling (e.g., interferes with venous return, normal breathing, appetite, and activities of daily living) such as in ascites attributable to hepatic encephalopathy or other causes.

 

Professional Considerations of Paracentesis (Peritoneal Fluid Analysis)

Consent form IS required.

Risks
Abdominal wall infection, hemorrhage, perforated bowel, increased peritonitis.
Contraindications
This procedure should be used with caution during pregnancy and in clients with coagulation abnormalities or bleeding tendencies.

 

Preparation

1. Have the client urinate or empty the bladder by catheterization. This will help prevent accidental bladder trauma.
2. Measure abdominal girth, weight, and baseline vital signs. Monitor vital signs every 10–15 minutes during the procedure.
3. Obtain povidone-iodine solution, sterile gauze sponges, 1%–2% lidocaine (Xylocaine), 10- and 30-mL syringes, 22- and 24-gauge needles, sterile gloves, sterile drapes, a trochar with a cannula, a sterile vacuum collection bottle, plastic tubing, a scalpel, suture, a needle holder, and tape.
4. Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.

 

Procedure

1. Position the client sitting on the edge of a bed or examination table with the back supported and the feet resting on a stool. The procedure may also be performed with the client lying supine.
2. Cleanse the client's abdomen with povidone-iodine solution and allow it to dry; then cover the areas surrounding the site with a sterile drape.
3. Numb the area with 1%–2% lidocaine (Xylocaine), first using a 22-gauge needle locally and then changing to a 24-gauge needle and anesthetizing the area deeper.
4. A scalpel is used to make a stab wound into the peritoneal cavity midway between the umbilicus and the symphysis pubis. Alternatively, the insertion may be through the iliac fossa, through the flank, or in each abdominal quadrant. The trochar-cannula is threaded through the incision. An audible sound may be heard when the needle pierces the peritoneum. The trochar is removed, and plastic tubing is attached to the cannula; the other end of the tubing is placed in the collection receptacle (usually a 500- to 1000-mL vacuum bottle). The fluid is slowly drained from the abdominal cavity. The client may need to be repositioned to improve drainage.
5. Do not drain more than 5 L at a time. If hypovolemia occurs as a result of rapid drainage, raise the bottle to slow the drainage rate or clamp the drainage tube. To reduce risk of infection, do not leave drain in place longer than 6 hours.
6. When the fluid collection is complete, remove the cannula, and suture the incision if necessary.

 

Postprocedure Care

1. Apply a dry, sterile dressing to the site.
2. Observe the site for bleeding or drainage.
3. Measure abdominal girth and weight.
4. Monitor vital signs for evidence of hemodynamic changes every 30 minutes for 2 hours, every hour for 4 hours, and then every 4 hours for 24 hours.
5. Write any recent antibiotic therapy on the laboratory requisition. Send the samples to the laboratory for analysis immediately.
6. Document in the client's record the time of the procedure; the name of the physician; the color, consistency, and amount of fluid withdrawn; and the client's response to the procedure.
7. Monitor daily sequential multiple analyzer (SMA7) blood work.
8. Observe for hematuria caused by bladder trauma. If this is suspected at the time of the procedure, a BUN and creatinine value obtained on the paracentesis fluid should be sent to confirm the condition.

 

Client and Family Teaching

1. Notify the physician immediately if you notice bloody, pink, or red urine.
2. Results are normally available within 72 hours.

 

Factors That Affect Results

1. Inadvertent internal organ injury, including female organs, may contaminate the sample with bile, blood, urine, or feces or with bacterial flora.
2. Delay in analysis may cause inaccurate results.
3. Care must be taken to ensure a sterile technique, especially in handling specimens for culture and Gram stain.

 

Other Data

1. Frequently, salt-poor albumin or mannitol is infused for 24 hours after paracentesis for clients with ascites and poor nutrition, which increase the third spacing of fluid into this cavity.
2. Transient initial bloody fluid may result from a traumatic tap.