paracentesis

Abdominal puncture (abdominocentesis) is a technique for the treatment of the peritoneal cavity directly from the anterior wall of the abdomen by means of a puncture needle. The exact name should be peritoneal puncture. Abdominal puncture is widely used in clinical work. Especially in the diagnosis of acute abdomen, timely abdominal wear can not only obtain a clear diagnosis, but also gain valuable time for treatment. This method is simple and fast, does not require special equipment, and the patient suffers little. Abdominal catheterization provides another route of treatment for cancer patients, especially advanced patients. Treatment of diseases: cirrhosis ascites Indication Diagnostic puncture (1) abdominal infection (such as underarm abscess and effusion, abscess around the appendix, intestinal abscess, etc.). (2) When the abdominal trauma is performed, the fluid is assisted for diagnosis (such as intra-abdominal hemorrhage, hollow organ perforation, etc.). (3) Abdominal perforation in patients with advanced cancer to confirm the diagnosis of abdominal metastasis (such as puncture and ascites exfoliative cytology, etc.). 2. Therapeutic puncture (1) peritoneal lavage or artificial pneumoperitoneum as a treatment. (2) intraperitoneal injection of drugs (such as chemotherapy drugs). (3) A large amount of ascites causes severe chest tightness and shortness of breath, and proper amount of fluid can relieve symptoms. Contraindications 1, extensive peritoneal adhesions. 2, there are signs of hepatic encephalopathy, echinococcosis and huge ovarian cysts. 3, a large number of ascites accompanied by severe electrolyte disorders are contraindicated a large amount of ascites. 4, mental abnormalities or can not cooperate. 5, pregnancy. Preoperative preparation 1, the operation room disinfection 2, check the patient's name, check the medical records, abdominal plain film and related auxiliary examination data 3, clean your hands (hand spray disinfectant or wash your hands) 4. Do a good job in the patient's ideological work, explain the purpose and general process of the puncture to the patient, eliminate the patient's concerns, and strive for full cooperation. 5, blood pressure, pulse, abdominal circumference, abdominal signs 6, preoperative sputum urination, in order to prevent stab wound bladder 7. Prepare a peritoneal puncture bag, sterile gloves, mask, cap, 2% lidocaine, 5ml syringe, 20ml syringe, 50ml syringe, disinfection supplies, tape, container, measuring cup, curved plate, 500ml saline, intraperitoneal injection The required medicines, sterile tubes (only routine, biochemical, bacterial, pathological specimens), multi-head belts, backrest chairs, etc. 8, wear a hat, a mask. 9. Guide the patient into the operating room. Surgical procedure 1. The patient first evacuates the urine, and the patient is seated on the backrest chair, or the reclining position is taken, the abdominal belt is laid on the back, and the plastic apron and the middle single are in the lower part of the abdomen. If the amount of ascites is small, the lateral position is taken. 2, puncture point can choose the umbilical and pubic symphysis midpoint (should avoid white line), or the outer 1/3 of the umbilical cord and the anterior superior iliac spine (usually choose the left side). 3. Regular skin disinfection. The surgeon is to be treated with sterile gloves, a sterile hole towel, and a local anesthesia to the peritoneum. Penetrate the abdominal wall with a puncture needle. After entering the abdominal cavity, you can use a syringe to pump a little ascites into a sterile test tube for inspection. Then, a latex tube is connected to the needle, and the ascites is introduced into the container. 4, the discharge speed should not be too fast, the amount of liquid should not be too much. In the discharge, the abdomen should be gradually tightened by the assistant. Do not suddenly relax, and closely observe the patient's face, blood pressure, pulse, and breathing. In the event of syncope, shock, discharge should be stopped, lying flat, and infusion, expansion and other emergency treatment. 5. After the liquid is discharged, take out the puncture needle, partially apply iodine and ethanol, cover the sterile gauze, fix it with tape, and tie the abdomen. It is advisable to check the abdomen carefully before the abdominal belt, such as hepatosplenomegaly and mass. If the needle hole has ascites oozing, it can be covered with fire rubber. 6. If the patient is diagnosed with abdominal puncture, the puncture juice can be directly used for intravenous puncture. Select the puncture site as before, no need to carry the abdomen.