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Abdominal Drainage 1056.e1

Abdominal Drainage
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Difficulty level: ♦
Possible Complications and point onward. Use sterile scissors for making
three to five additional drainage holes in the
Synonyms Common Errors to Avoid red rubber feeding tube to avoid omental
Large-volume abdominal paracentesis, perito- • Overall, complications very uncommon; plugging during drainage.
neal drainage approximately 5%-10% incidence of irrita- ○ To make extra holes before inserting the
tion or dehiscence of incision, responding tube into the abdomen, kink the red
Overview and Goal to topical treatment. Major complications rubber feeding tube with thumb and
The goal of abdominal drainage is to improve are < 1%. forefinger and snip off the corner of the
comfort and ease of respiration in animals with • Concerns for hypovolemia, hypotension, folded edge; unfolded edge reveals a small
massive ascites. hypoalbuminemia, and ascending bacterial oval hole (needs to be < 40% of tube’s
peritonitis appear unjustified, given lack of circumference to prevent weakening it). Procedures and Techniques
Indications occurrence in large case series (unpublished Repeat to make several holes along the
• Tense ascites (p. 79) caused by chronic passive data). distal half of the tube. The scissors are
congestion (right heart failure, chronic • Elizabethan collar must be on the animal kept sterile for later in the procedure.
hepatopathies) at all times during drainage to avoid self- • Using the #11 scalpel blade, make a stab
• Abdominal compartment syndrome induced damage to the tube. incision cranial to the umbilicus on the
• Cover grate-type cage flooring with a towel to ventral abdominal midline at the center of
Contraindications prevent the tube ± stopcock from becoming the lidocaine-infiltrated area.
• Hemoabdomen: voids autotransfusion; delays caught after the animal is returned to the ○ To avoid an excessively large incision,
control of cause of hemoabdomen cage with the drain in place. hold the #11 scalpel blade between the
• Bleeding disorder: risk of hemorrhage if thumb and forefinger. The point at which
laceration of abdominal organ occurs with Procedure the blade is held between the thumb and
needle tip • Clip ventral abdomen widely, with umbilicus forefinger leaves a maximal width of the
approximately at center of clipped area. exposed blade that is the same as or just
Equipment, Anesthesia Because the procedure does not require slightly greater than the diameter of the
• Local anesthesia: 2% lidocaine ± 8.4% surgical draping, long hair must be trimmed red rubber feeding tube to be inserted; the
sodium bicarbonate back extensively. fingertips act as a guard to prevent exces-
• Manual restraint; sedation needed only rarely. • Restrain in either lateral recumbency. sive insertion of the blade. For example,
NOTE: Animals often are restless during • Wide surgical scrub and prep, centered on if a 10 Fr red rubber feeding tube will be
restraint because of pressure of ascites on ventral abdominal midline and just cranial used (approximate outer diameter of tube
diaphragm; in such cases, the procedure may to the umbilicus is 6 mm), then the scalpel blade should
be preceded by large-volume needle centesis • Lidocaine infusion at planned point of entry; be held such that the maximum exposed
(p. 1056) or may need to be performed with on abdominal midline, generally just cranial width of the blade (at the fingertips) is
the animal in standing position. to the umbilicus. 6 or 7 mm.
• Hair clippers, surgical scrub solution, rubbing ○ Discomfort from lidocaine minimized by • The blade is set aside but kept sterile in case
alcohol, and gauze/sponge for prepping skin adding sodium bicarbonate (9 : 1 ratio) and enlargement of the incision is necessary.
• Alligator forceps (preferable) or mosquito warming solution to body temperature • The tube is inserted into the abdomen. Tube
hemostats, 1 pair ○ Use multiple (e.g., 6-8) small subcutaneous insertion is facilitated by grasping the tip in
• Red rubber feeding tube: sterile 5-16 Fr tube, boluses. Keep in mind that 2% lidocaine the lower jaw of an alligator forceps, closing
based on body size = 20 mg/mL, and toxic dose of lidocaine the forceps, and advancing tube and forceps
• Sterile surgical gloves is roughly 8 mg/kg (dog) or 2 mg/kg (cat). through the hole. Mosquito forceps are an
• Suture material (e.g., nylon 2-0) and needle ○ Greater distance from prepuce preferred acceptable alternative. Often, the hole in
• A sterile #11 scalpel blade in males to lessen risk of contamination; the skin and the hole in the body wall are
• Sterile needle holders avoid such cranial placement that an not exactly aligned because of imperceptible
• Sterile suture scissors enlarged liver might impact procedure shifting of the tissue planes. Blunt probing
• Elizabethan collar ○ Lidocaine infusion must be wide (cranial- with the tube and forceps may be necessary
• Sterile gauze squares (postprocedure) caudal, left-right) and deep (reaching all to find the hole in the abdominal wall. If
• Tissue glue (postprocedure) layers, including peritoneum) and involves excessive pressure is required, the incision
injecting many small pockets of lidocaine may need to be enlarged using the #11 scalpel
Anticipated Time throughout the region of the planned blade.
15-40 minutes, plus drainage time incision. • Any sign of discomfort on the animal’s part
○ CAUTION: When redirecting, avoid is an indication for additional lidocaine
Preparation: Important Checkpoints subcutaneous tissue laceration with the infiltration at and around the insertion site.
• Advise owner needle tip. After each infiltration of a small • After the tube is inserted appropriately (a
○ Hair clipping required pocket of lidocaine, partially withdraw release of pressure may be apparent as the
○ Procedure generally palliative; underlying the needle, redirect it, and then readvance tube pierces the peritoneum and initiates
problem not corrected it for the next infiltration. The multiple voluminous flow of ascites), it is advanced
○ Low risk of infection or other complica- infiltrations can be accomplished by a until it protrudes from the abdominal wall
tions single point of needle entry (i.e., radial by only 1-2 inches (several cm).
• Weigh animal immediately before procedure redirection of the needle). • The tube is sutured in place using 2-0 or 3-0
(to quantify volume of fluid lost). • After opening the sterile gloves, keep the nylon, with a circumferential purse-string
• Have Elizabethan collar ready to place on the paper wrapper flat, and use as a sterile and a transfixation (suture through the tube)
animal as soon as tube placement is complete. surface. Wear the sterile gloves from this ligature.

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