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Percutaneous Paracentesis (Adult & Pediatric) (11.10-AP)

Percutaneous Paracentesis (Adult & Pediatric) (11.10-AP) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Diagnostic Tests and Procedures

11.10-AP

NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
May 4, 2017

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 11.10AP

Original
Revision

Page
1
of 4

Title: Percutaneous Paracentesis (Adult &
Pediatric)

I. PURPOSE

To provide guidance in assisting a bedside (?)paracentesis procedure for diagnostic or
therapeutic purposes.

II. POLICY
A. A provider order is required.
B. The procedure will be performed by a provider who will indicate the reason for the
paracentesis.

III. EQUIPMENT

A. Paracentesis kit (Central Service [CS] Item Number 1220065)
1. For pediatrics, stocked in PICU supply room.
B. Sterile gloves
C. Chux pads
D. 4x4 gauze pads
E. Tape
F. Tegaderm
G. Paracentesis vinyl connecting tube (CS Item Number 2200257) (Adult only)
H. 1,000 mL evacuated container bottles – 1-6 bottles may be used (CS Item Number
9996054) (Adult only)
1. For pediatrics, use 30 and 60 mL syringes.
I. Laboratory requisitions, as ordered
J. Specimen containers, as ordered
K. Resuscitative and monitoring equipment (Refer to UWHC Administrative Policies
8.38, Adult Sedation Policy and 8.56, Pediatric Sedation Policy for Moderate
Sedation.)

IV. PROCEDURE

A. Pre-procedure preparation
1. Verify order for procedure and any medication orders. Ensure informed
consent form is completed.
2. Review laboratory studies, including platelets and INR, and medication
administration record (MAR) for anticoagulants that may have been
administered

Page 2 of 4

a. Notify radiologist or provider if INR greater than 3.0 and/or platelets
are less than 160-370 K/uL or with other specific parameters as written
by the provider.
b. Notify the provider if the patient is on any anticoagulation
medications. Refer to Coagulation Guidelines for Invasive Procedures,
Department of Radiology Abdominal Imaging Division on U-Connect.
3. Verify the need for venous access. Refer to Nursing Patient Care Policy 1.23
Continuous Peripheral Intravenous Therapy (Adult & Pediatric).
4. For all procedures requiring sedation, refer to UWHC Administrative Policies,
8.38 (Adult Sedation) and 8.56 (Pediatric Sedation) for additional
requirements.
5. Prior to the procedure, the following must be performed and documented
consistent with UWHC Administrative Policy 8.48, Operative, Invasive, and
Other Procedures:
a. Pre-procedural patient identification
b. Site marking
c. Active "Time Out"
d. Universal Protocol
B. Paracentesis procedure
1. Perform hand hygiene according to UWHC Administrative Policy 13.08,
Hand Hygiene.
2. Follow standard and transmission based precautions according to UWHC
Administrative Policy 13.07, Standard Precautions & Transmission-based
Precautions (Isolation) in Inpatient Settings.
3. Assess patient condition and vital signs. Notify physicians of changes in
condition.
4. Assist with the following activities during the procedure:
a. Position patient supine in the bed.
b. Expose abdomen and protect patient’s clothing or gown with chux.
c. Administer moderate sedation, if applicable.
d. Monitor and document respiratory status, vital signs and amount of
fluid removed.
e. Change evacuated container bottles when full and transfer specimens
to appropriate collection bottles.
f. Label specimens in the presence of the patient according to UWHC
Clinical Laboratories Policy 1502.5.06, Acceptance Policy for
Specimen Identification and send specimens to the lab, as ordered.
5. The radiologist or provider may order the RN to monitor drainage and remove
the catheter (adult only for removal).
a. If the radiologist/physician/provider leaves the bedside, obtain the
name of who to contact for the following:
i. Any indications that all of the fluid has not been removed
ii. Any problems with the catheter
iii. When the catheter is to be removed
b. Prior to the radiologist or provider leaving the bedside, ensure that the
catheter is anchored with tape to prevent accidental catheter
dislodgement.
c. Monitor patient vital signs, site and drainage every 15 minutes and as
needed during drainage.

Page 3 of 4

d. Monitor flow of the fluid and change evacuated container bottles/bag
when full.
e. Once flow of the peritoneal fluid has ceased, consider repositioning
the patient gently from side to side to facilitate drainage.
f. Radiologist/provider or RN may remove catheter (adult only). If the
RN is to discontinue the paracentesis catheter, verify that an order to
discontinue is written.
i. In pediatrics, ONLY the radiologist/provider may remove
catheter. Ensure this plan is communicated before the
radiologist or /provider leaves the bedside.
g. Remove the catheter by gently pulling out and applying pressure to the
wound for 3-5 minutes.
h. After pressure has been applied for 3-5 minutes, dress puncture site
with sterile 2x2 gauze pad and transparent dressing.
i. Inspect catheter to ensure it is intact.
C. Post-procedure
1. Post-procedure monitoring
a. Obtain vital signs and site assessment every 15 minutes x 1 hour, or
according to provider order. Notify radiologist/provider if there is
continued leaking from site.
b. Notify provider if the patient reports or demonstrates: dizziness, pallor,
diaphoresis signs and symptoms of peritonitis (rigid abdomen, fever,
chills or moderate to severe abdominal pain).
c. Post-paracentesis orders may contain sliding scale for albumin (for
cirrhosis or liver disease due to non-cancer related diagnoses). Contact
the provider ordering the paracentesis with questions regarding
albumin (adult only).
d. If moderate sedation has been administered, follow post procedure
monitoring until all criteria have been met for Phase I and Phase II. If
no moderate sedation, monitor patient until cleared by the procedural
provider.
2. Dispose of drainage bags or evacuated bottles with fluid according to
Administrative Code NR 526, Medical Waste Management.
3. In the clinical record, document the following:
a. Date and time procedure was performed
b. Name of radiologist or provider
c. Amount, color and consistency of fluid withdrawn
d. Puncture site assessment
e. Patient's tolerance of the procedure
4. If the patient is to return home after the procedure, provide post procedure
education about monitoring respiratory effort, signs of hypotension, increased
pain, redness or swelling around puncture site. Complete discharge
instructions according to provider order, may vary by patient. Refer to Health
Facts For You 6375, Paracentesis in Ultrasound.

V. UWHC CROSS REFERENCES

A. UWHC Clinical Laboratories Policy 1502.5.06, Acceptance Policy for Specimen
Identification

Page 4 of 4

B. Coagulation Guidelines for Invasive Procedures, University of Wisconsin
Department of Radiology Abdominal Imaging Division
C. Health Facts for You 6375, Paracentesis in Ultrasound
D. Administrative Code NR 526, Medical Waste
E. Nursing Patient Care Policy 1.23 Continuous Peripheral Intravenous Therapy
(Adult & Pediatric).
F. UWHC Administrative Policy 8.38, UWHC Adult Sedation Policy
G. UWHC Administrative Policy 8.48, Operative, Invasive & Other Procedures
H. UWHC Administrative Policy 8.56, Pediatric Sedation Policy
I. UWHC Administrative Policy 13.07, Standard Precautions & Transmission-based
Precautions (Isolation) in Inpatient Settings
J. UWHC Administrative Policy 13.08, Hand Hygiene

VI. REFERENCE

Lynn-McHale Wiegand, D. J. (Ed.). (2011). AACN Procedure Manual for Critical
Care (6th Ed.). Philadelphia, PA: WB Saunders Co.

VII. REVIEWED BY

Clinical Program Coordinator, Ultrasound
Clinical Nurse Specialist, Trauma Life Support Center
Clinical Nurse Specialist, Acute Medicine and Progressive Care
Clinical Nurse Specialist, Trauma/Surgical IMC and Burn Unit
Clinical Nurse Specialist, Pediatric Intensive Care Unit (PICU)
Nursing Patient Care Policy and Procedure Committee, April 2017

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive