Page 2117 - Cote clinical veterinary advisor dogs and cats 4th

1056 Abdominocentesis Acupuncture

Abdominocentesis
VetBooks.ir

Preparation: Important
Difficulty level: ♦
Checkpoints • For diagnostic samples: connect syringe to
needle
Synonyms • Assess patient’s risk of coagulopathy. • Advance needle through the skin and body
Paracentesis, abdominal tap • If in doubt based on exam, confirm presence wall at an oblique angle with the needle
of abdominal fluid with US. pointing craniad (i.e., needle is not inserted
Overview and Goal • Have supplies at the ready. straight in perpendicular to abdomen).
Obtain abdominal fluid samples for diagnostic Aspirate fluid and collect into a red and
purposes. Possible Complications and purple top for diagnostic tests.
Common Errors to Avoid • Remove the needle following the same direc-
Indications • Failure to obtain sample: use US guidance tion as it was inserted; the oblique angle
• Abdominal distention with fluid wave • Potential laceration of visceral organs allows the tissue to close over the track.
• Ultrasound (US)–identified free abdominal ○ Restrict needle movement to in-and-out • Always document the amount of fluid that
fluid motion, with minimal side-to-side motion has been removed, including a detailed
• Can be combined with abdominal drainage ○ Use US guidance if small fluid volume description of the fluid.
for relief of physical pressure due to ascites • Subcutaneous fluid accumulation: minor
(p. 79) complication, typically resolves spontaneously Postprocedure
• Submit fluid for analysis (p. 1343). In
Contraindications Procedure addition to cytology, cell count, and total
• Coagulopathies (p. 1325); relative contra- • Positioning depends on patient comfort, protein, other assays can include hematocrit,
indication and benefit may outweigh small temperament, and fluid volume. For creatinine, potassium, triglyceride, culture, or
risk large volume of fluid, lateral recumbency polymerase chain reaction (PCR), depending
• Abdominal distention due to mass or commonly used if animal is comfortable. on clinical suspicion.
organomegaly rather than fluid Otherwise, standing allows fluid to pool • Monitor patient for subcutaneous fluid
ventrally but requires extra attention to accumulation around collection site. An
Equipment, Anesthesia restraint. abdominal wrap may be placed if this occurs,
• +/− US unit (helpful for small volume or • Clip hair and aseptically prep site, typically being aware of patient’s respiratory effort.
isolated fluid pockets) selecting ventral aspect of the abdominal
• Sterile gloves midline close to the umbilicus. Other sites Alternatives and Their
• Chlorhexidine scrub and solution may be chosen if US guidance is used to Relative Merits
• If only diagnostic sampling planned: 22-gauge find isolated fluid pocket. • Abdominal drainage: to remove large volume
× 1-inch needle and 6- to 10-mL syringe • If planning to remove a large volume: select of abdominal fluid that compromises patient
• If diagnostic procedure combined with appropriate catheter size for the patient and comfort or respiration. Aliquots can be
therapeutic abdominal drainage: the amount of fluid to be obtained. With submitted for fluid analysis.
○ Intravenous (IV) catheter or butterfly sterile gloves and technique, attach the • Diagnostic peritoneal lavage: to retrieve
catheter set (depends on size of patient extension set to the catheter on one end diagnostic samples of small amounts of
and amount of fluid) and the 3-way stopcock on the other for abdominal fluid. Often requires sedation and
○ Extension set the syringe to attach to. An assistant may not always a guaranteed sample collection.
○ 3-way stopcock be necessary to aspirate.
○ Syringe (size depends on patient and ○ If using an IV catheter, the stylet should AUTHOR: Savanah Smith, RVT
amount of fluid) be removed after insertion through the EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
Thompson, DVM, DABVP
○ Bowl for waste fluids abdominal wall to prevent any lacerations
• Sample tubes (red top, purple top) of other organs. However, this may make
• +/− sedation, depends on patient’s disposition it difficult to pull copious amounts of
fluid, especially if using a small catheter.
Anticipated Time A butterfly catheter may be used for a
5-15 minutes shorter needle size.

Acupuncture Bonus Material
Online

Difficulty level: ♦♦ as a maintenance therapy for a lifelong and particular virtues in a given clinical
condition in ≈80% of cases. setting.
Overview and Goal • There are indications for the use of acu- • Several neurophysiologic mechanisms
• Acupuncture may be used in concert with puncture as an adjunct treatment for specific describe acupuncture effects. Spinal gates,
other methods of integrative pain manage- visceral organ diseases. central nervous system (CNS) endorphin
ment for the control of acute or chronic • The many different techniques (e.g., heat, release, and viscerocutaneous reflex arcs are
pain. needles, laser, implant) used for stimulating a few of them.
• Many clinicians report that acupuncture an acupuncture point may be a source of • There are four different schools of acupunc-
resolves the clinical problem or serves well confusion. Each method has its purpose ture thought: traditional Chinese medicine

www.ExpertConsult.com