Paracentesis: Difference between revisions
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===SBP=== | ===SBP=== | ||
Any: | Any: | ||
*>500 WBC | |||
*>250 PMNs | |||
*Positive gm stain (single microbe) | |||
^For bloody tap, subtract 1 WBC for every 250 RBC | ^For bloody tap, subtract 1 WBC for every 250 RBC | ||
| Line 51: | Line 51: | ||
===Consider Peritonitis (eg. perf appy, chole)=== | ===Consider Peritonitis (eg. perf appy, chole)=== | ||
Any: | Any: | ||
* >10,000 WBC | |||
* Polymicrobial gm stain | |||
* Total protein >1g/dL | |||
* Glu <50 | |||
* Increased LDH | |||
===If on Peritoneal Dialysis=== | ===If on Peritoneal Dialysis=== | ||
SBP if: | SBP if: | ||
*>100WBC OR >50% NEUT | |||
===If on Nightly APD=== | ===If on Nightly APD=== | ||
SBP if: | SBP if: | ||
* >50%NEUT | |||
* Amyase (>100 suggestive of intra-abd process) | |||
==See Also== | ==See Also== | ||
Revision as of 07:50, 30 May 2015
Equipment
- Lidocaine with epi
- chlorhexidine
- Paracentesis kit (catheter, 11 blade, syringes, bandaid)
- Ultrasound
- Vacuumed bottles
Contraindications
See Procedures in Patients with Coagulopathies
Procedure
- Use ultrasound to identify safe ascites pocket to drain
- if no ultrasound available, can percuss to identify pocket
- Try to pick site away from inferior epigastric artery
- LLQ preferred over RLQ
- Midline infraumbilicus is avascular (linea alba) but has lower success rate
- Prep area
- Anesthesize area with Lidocaine
- Use needle to enter peritoneum, advance catheter upon withdrawing ascitic fluid
- Attach cathether to vacuum bottles for therapeutic tap, Withdrawal with syringe for diagnostic tap
- tip: Placing Cx in BCx tube increases yield
Workup
- Cell count with dif
- Cx (BCx bottles)
- Grm stain
Consider:
- Albumin and SERUM albumin
- Protein
- Glucose
- LDH and SERUM LDH at same time
- Amylase
Specific circumstances:
- TB smear and Cx
- Cytology
- TG
- Billirubin
Diagnosis
SBP
Any:
- >500 WBC
- >250 PMNs
- Positive gm stain (single microbe)
^For bloody tap, subtract 1 WBC for every 250 RBC
Consider Peritonitis (eg. perf appy, chole)
Any:
- >10,000 WBC
- Polymicrobial gm stain
- Total protein >1g/dL
- Glu <50
- Increased LDH
If on Peritoneal Dialysis
SBP if:
- >100WBC OR >50% NEUT
If on Nightly APD
SBP if:
- >50%NEUT
- Amyase (>100 suggestive of intra-abd process)