Therapeutic Paracentesis – Management of Ascites (Nursing)

00:01 Now our fourth interprofessional goal is paracentesis.

00:05 This is a procedure but here's a note before we walk into the procedure.

00:09 I want you to know about that last word there esis.

00:14 That means In term about movement of fluid.

00:18 So if I have a diuresis it also has esis, so paracentesis, diuresis, any of those things that say esis, I'm thinking about fluid volume shifting.

00:34 With a paracentesis, this is a key complication of liver cirrhosis is ascites and a paracentesis is what helps us remove that fluid.

00:44 So you've got the picture there that you're familiar with right? See the spinal column, the liver, the stomach, the intestines, and then the ocean we call ascites, right? That's the blue color that you see there.

00:57 We try to manage paracentesis with a low sodium diet, remember that two gram sodium diet and diuretics.

01:05 When that doesn't work when the patient is still experiencing pathological ascites.

01:10 Now, we're gonna have to move into something that's a little more intense and a lot more invasive.

01:16 So we first we start with drug therapy and dietary restriction when that's not effective. We're going to do a paracentesis.

01:25 So once we arrive at the point of needing a paracentesis, what's my role as a nurse? And what's the healthcare practitioners role? Well, my role as a nurse is to make sure the patient is ready for the procedure and then during and after the procedure, my job is to monitor that patient for safety.

01:44 So here's some things that you want to know that are particular to a paracentesis.

01:48 Now we're going to stick a needle right into the abdomen.

01:51 So we want to make sure we don't nick the bladder so immediately before the procedure, make sure the patient empties their bladder because we want to make it a smaller target, minimize the risk of actually nicking that bladder.

02:04 If you nick that bladder, urine is going to be leaking into the abdominal cavity and that reeks all kinds of havoc.

02:11 Now keep in mind we're removing fluid, right? So anytime you cause fluid to shift that esis.

02:19 Patient is at risk for low volume and a drop in their blood pressure.

02:24 So you want to closely monitor their blood pressure, know what their normal is so you'll recognize when there's a significant change.

02:32 Because these patients getting a paracentesis are at increased risk for both electrolyte imbalances and hypovolemia.

02:40 So you got to watch them really really closely.

02:44 All right. There's the abdomen you seen before and the rest of our video series.

02:47 That's a patient clearly with ascites, right? What are those little marks that you see on their abdomen? There either striae from the stretching of the abdominal wall, or they could even be vessels.

03:00 But paracentesis is an invasive procedure.

03:04 Okay, we use a large-bore needle and it's inserted into the abdomen. Yeah.

03:10 It's pretty big deal.

03:11 So don't overlook that concept with your patients take the average human explain to them that you're going to take a large bore needle and puncture them. Like a water balloon usually gets people a lot nervous.

03:23 So what you want to do is make sure you explain the procedure to them but doctor will come in and you'll get a consent signed but what you're talking about is just as a nurse to the patient.

03:36 Hey, let me tell you what's going to happen and what you can expect and I'll be right here with you in case you have any questions if you feel extremely uncomfortable.

03:45 Just let me know and you talk them through it.

03:48 That's Not the same as getting an informed consent.

03:52 That's the physician scope of practice.

03:55 My scope of practice as the nurse is to help them remain calm.

04:00 Give them as much knowledge as they need to know what to expect so that will help them stay calm and focused and I always make great eye contact with my patients during a procedure so that they know someone is watching them and taking care of them.

04:15 Sometimes we get into this bad habit or doing a procedure that forget that that's a human laying there and that is a person that you should still be interacting with, checking in on and seeing how they're feeling.

04:29 Okay this is a cool graphic. I love this one.

04:31 You're really familiar with it now, you see the liver the stomach, the intestines, the ocean of ascites, but look at that, we're going to stick a needle in their connected to tubing and you're going to drain that into a container.

04:46 Okay that's important for you to know.

04:48 We're going to stick the needle in there to penetrate the skin and get into the fluid and then it's going to drain through this tubing into a container.

04:57 Doesn't matter what the container looks like.

04:59 It'll look different at every facility.

05:01 You just get the concept.

05:03 You're going to pierce the skin stick the needle right into where the fluid is, then we're going to connect tubing to it so it can drain.

05:13 Keep in mind when you're removing fluid.

05:16 You think you want to do it quickly to get this over or should you do it slowly.

05:21 Yeah, slowly, nice and slowly.

05:26 Because if I pull fluid out, that patient is really at risk for circulatory collapse and when I say that I mean, their blood pressure tanks, now, we've got a much bigger problem.

05:39 So fluid is drained over a period of minutes up to a few hours depending on how much is being withdrawn how stable or unstable the patient is.