Laparocentesis
Last reviewed: 23.04.2024
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[Technique of laparocentesis
Before the procedure, you need to perform a general blood test, determine the number of platelets and examine the state of coagulation. After emptying the bladder, the patient sits on the bed, reclining by 45 °. In patients with obvious and diagnosed ascites, the puncture site is located along the midline between the navel and the pubic bone and is treated with antiseptic and alcohol. In patients with moderate ascites, the exact location of ascites fluid is identified with ultrasound of the abdominal cavity. In sterile conditions, the puncture zone is anesthetized to the peritoneum with a 1% solution of xichain. For a diagnostic laparocentesis, a 18 gauge needle attached to a syringe (50 ml) is guided through the peritoneum (as a rule, a characteristic popping sound is noted). Fluid without effort is dialed into a syringe and sent to the laboratory for counting cells, protein or amylase content, for cytology or bacteriological culture. For therapeutic (with large volume) laparocentesis, a 14 gauge hollow needle is used, connected to a vacuum aspiration system, which is necessary for evacuation to 8 liters of ascitic fluid. Postmanipulation hypotension caused by redistribution of the fluid, with interstitial edema observed rarely.
Laparocentesis: contraindications
Absolute contraindications to laparocentesis include severe, incurable abnormalities of blood clotting; intestinal obstruction; infection of the abdominal wall. Difficult contact with the patient, scars after surgical interventions in the puncture area and severe portal hypertension with a pronounced collateral venous network on the abdomen are relative contraindications.