Page 41 - Radiology Book

labs to order on Paracentesis
All
Optional
Unusual
Cell count and differential
Glucose
TB smear/culture
Albumin
LDH
Cytology
Total protein
Amylase
TG, total bili
Gram stain
pH
Serum albumin
Cultures in blood culture bottles
Paracentesis continued
Paracentesis Extras
· For cytology, send sterile vacuum bottle with 5,000 units heparin added.
· For pH, send 10 mL in an anaerobic syringe (gas bubbles removed) on ice.
· Preferred method for bacteriology is bedside inoculation of blood culture bottles; more sensitive in detecting bacterial growth in ascites uid than delaying inoculation by microbiology laboratory. Send the cell count as STAT to prevent treatment delay.
Parcentesis Procedure
1. Have patient empty their bladder.
2. Con rm location of ascites using US (mark entrance site) with patient in a semirecumbent position.
3. Prepskin,laydrapes,in ltrateskinwithlidocaine(small 27-gauge needle), and in ltrate deeper using an 18–22-gauge needle.
4. Retract skin caudally and insert catheter and needle (attached to syringe) to form a “Z-track” to minimize ascites leakage.
· When ascites uid returns freely, hold
the needle in position and advance the catheter. Withdraw the needle to avoid bowel trauma. Multiple aliquots (50 mL each) may be obtained in this manner.
· Tocollectlargervolumes,removethesyringeanddirectly attach the thoracentesis set to the 22-gauge needle to allow drainage into vacuum bottles. Once the desired amount is collected, quickly withdraw the needle to allow the skin to return to its normal position. Tip: Place small pillow under opposite site ank to help move ascites to the tap side.
5. Check
· Is the uid infected? Is portal HTN present?
39
6. SAAG = [albumin]serum
-
[albumin]
ascites uid
Procedures