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Indication :
Diagnostic : Ascites etiology, Peritonitis (Spontaneous bacterial peritonitis), Malignancy
Therapeutic : Symptoms relief (Respiratory compromise or abdomen tense)
Contraindication :
Coagulopathy
Pregnancy
Ileus
Bladder distension
Puncture site ongoing infection
- Large-volume paracentesis with complications of hypotension, hyponatremia, renal impairment, and encephalopathy
- Risk of paracentesis : bowel perforation, ascitic fluid leak, hemorrhage, and introduction of infection.
- Consider correcting deficiencies before paracentesis :
severe coagulopathy (INR >2.5) or thrombocytopenia (platelets <50,000/μL)
US guidance can assist in avoiding subcutaneous vessels dilated by portal hypertension,
and it decreases the risk of bleeding
1. Patient position 擺位最重要,
略側躺可以讓腹水往一側累積
2. Echo guide 先定位, 標記位置
找水最深, 最適合下針處
可超音波預估皮下/肌肉的軟組織深度
探頭不要過度加壓皮膚, 造成誤判入針適合的深度
記得探頭定位的角度
等下入針也要保持同樣角度
最好就是垂直體表
puncture 最重要是垂直體表入針, 不然針走進皮下
3. 無菌消毒, 洞巾, 最大無菌操作面
4. 個人不打 locol
5. 抽腹水針要先把後面蓋子拔掉 接針筒
左手算好適合的預估深度
右手入針後維持反抽
按照左手持針定位好的深度直接入針
抽到腹水後推軟針到底再退硬針
http://zh.scribd.com/doc/162404241/%E8%8A%B1%E8%93%AE%E6%85%88%E6%BF%9F%E8%85%B8%E8%83%83%E5%85%A7%E7%A7%91-%E6%8A%BD%E8%85%B9%E6%B0%B4%E6%AD%A5%E9%A9%9F%E6%95%B4%E7%90%862013%E5%B9%B48%E6%9C%8826%E6%97%A5-%E7%89%88%E6%9C%AC#scribd
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