Type of test Fluid analysis

Normal findings

Gross appearance: clear, serous, light yellow, < 50 mL

Red blood cells (RBCs): none

White blood cells (WBCs): < 300/μL

Protein: < 4.1 g/dL

Glucose: 70-100 mg/dL

Amylase: 138-404 units/L

Ammonia: < 50 mcg/dL

Alkaline phosphatase: Adult male: 90-240 units/L

Female < 45 years: 76-196 units/L

Female > 45 years: 87-250 units/L

Lactic dehydrogenase (LDH): similar to serum LDH

Cytology: no malignant cells

 Bacteria: none

Fungi: none

Carcinoembryonic antigen (CEA): negative

Test explanation and related physiology

Paracentesis is an invasive procedure entailing the insertion of a needle or catheter into the peritoneal cavity (Figure 1) for removal of ascitic fluid for diagnostic and therapeutic purposes.

Fig1. Paracentesis. A catheter is placed through the skin and abdominal muscle wall and into the peritoneal cavity containing free fluid.

Diagnostically, paracentesis is performed to obtain and analyze fluid to determine the etiology of the peritoneal effusion. Peritoneal fluid is classified as to whether it is a transudate or exudate. This is an important differentiation and is very helpful in determining the etiology of the effusion. Transudates are most frequently caused by congestive heart failure, cirrhosis, nephrotic syndrome, myxedema, peritoneal dialysis, and hypoproteinemia. Exudates are most often found in infectious or neoplastic conditions. However, collagen vascular disease, gastrointestinal (GI) diseases, trauma, and drug hypersensitivity also may cause an exudative effusion.

Therapeutically, this procedure is done to remove large amounts of fluid from the abdominal cavity.

Urea and creatinine may be measured if there is a question that the fluid may represent urine from a perforated bladder.

Contraindications

• Patients with coagulation or bleeding abnormalities

• Patients with only a small amount of fluid and extensive previous abdominal surgery

Potential complications

• Hypovolemia if a large volume of peritoneal fluid is removed

• Peritonitis

 Procedure and patient care

 Before

* Explain the procedure to the patient.

 • Obtain informed consent for this procedure.

* Tell the patient that no fasting or sedation is necessary.

* Have the patient empty the bladder before the test.

• Measure abdominal girth.

• Obtain the patient’s weight and baseline vital signs.

 During

• Note the following procedural steps:

 1. Place the patient in a high Fowler position in bed.

 2. Paracentesis is performed under a strict sterile technique.

3. The needle insertion site is aseptically cleansed and anesthetized locally.

 4. A scalpel may be used to make an incision in the skin to allow the cannula or needle to enter.

5. A trocar, cannula, or needle is threaded through the incision.

6. Tubing is attached to the cannula. The other end of the tubing is placed in the collection receptacle (usually a container with a pressurized vacuum).

 • Note that this procedure is performed by a physician at the patient’s bedside, in a procedure room, or in the physician’s office in less than 30 minutes. Usually the volume removed is limited to about 4 L at any one time to avoid hypovolemia if the ascites is rapidly reaccumulated.

* Although local anesthetics eliminate pain at the insertion site, tell the patient that he or she will feel a pressure-like discom fort as the needle is inserted.

 After

 • All tests should be performed immediately to avoid false results because of chemical or cellular deterioration.

 • Place a small bandage over the needle site.

 • Observe the puncture site for bleeding, continued drainage, or signs of inflammation.

• Measure the abdominal girth and weight of the patient; com pare with baseline values.

 • Monitor vital signs for evidence of hemodynamic changes.

• Because of the high protein content of ascitic fluid, albumin infusions may be ordered to compensate for protein loss.

 • Occasionally ascitic fluid will continue to leak out of the needle tract after removal of the needle. A suture can stop that. If unsuccessful, a collection bag should be used.

Abnormal findings

 Exudate

- Lymphoma

- Carcinoma

- Tuberculosis

- Peritonitis

- Pancreatitis

- Ruptured viscus

Transudate

- Hepatic cirrhosis

- Portal hypertension

- Nephrotic syndrome

- Hypoproteinemia

- Congestive heart failure

- Abdominal trauma

- Peritoneal bleeding

اخر الاخبار

اخبار العتبة العباسية المقدسة

قسم الشؤون الفكرية يستعد لافتتاح موكب سقّاء عاشوراء في النجف الأشرف

المجمع العلميّ يُجري اختبارات نظريّة وتطبيقيّة لطلبته في قضاء الحمزة الشرقيّ

لطلبتها وملاكاتها جامعة الكفيل تواصل تنظيم الورشة التدريبية للإسعافات الأولية استعدادًا لزيارة الأربعين

مصنع الجود للمحاليل الوريدية: نحرص على إنتاج دواءٍ آمن وفعّال بأيدٍ وطنيّة دعمًا للقطّاع الصحي العراقي

المزيد

الآخبار الصحية

"شعور لا مفر منه" في الحياة يهدد حياة الملايين بالموت المبكر!

أعراض للخرف قد تظهر في المشي.. كيف نكتشفها؟

ماذا يحدث لسكر الدم عند شرب القهوة؟

سرطان القلب.. لماذا يعد من أندر أنواع السرطانات؟

المزيد

الآخبار التكنلوجية

صهر أردوغان يطلق منصة تواصل جديدة.. تنافس فيسبوك ؟!

غوغل تطلق "مرشد الويب" لتنظيم نتائج البحث بالذكاء الاصطناعي

بعد 20 عاما.. رصد أصغر أفعى في العالم مجددا في بربادوس !

ذكر أم أنثى؟.. دراسة تنسف الاعتقاد الشائع حول جنس المولود

المزيد

مواضيع ذات صلة

Partial thromboplastin time, activated (APTT, Partial thromboplastin time [PTT])

parathyroid scan (Parathyroid scintigraphy)

parathyroid hormone (PTH, Parathormone)

Clinical Immunology Laboratory (Diagnostic Testing)

Determination of Type D and Rh Phenotype

Determination of the ABO Group

Platelet and Granulocyte Antigens and Antibodies

pancreatobiliary fish testing

pancreatic enzymes (Pancreatic secretory test, Amylase, Lipase, Trypsin, Chymotrypsin)

pancreatic elastase (PE, EL1, Elastase-1, Fecal Elastase)

Trends in Immunoassay Automation

Flow Cell Cytometry