Abdominocentesis
Posted: Wednesday, January 1st, 2020 | Updated: Sunday, January 15, 2023
Posted: Wednesday, January 1st, 2020 | Updated: Sunday, January 15, 2023
The Prep
Aseptically clip and scrub the desired sampling area with the proper antimicrobial solution. Doing so greatly reduces the risk of infection. Ultrasonography can be used to observe the best area for sampling. Samples may be otherwise likely be obtained 1 to 2 cm caudal to the umbilicus on midline when an ultrasound is unavailable. Skin blocks and/or sedation can be used on a patient to patient basis
Obtaining a Diagnostic Sample
Wearing gloves, carefully insert a 22 or 20 gauge needle or over-the-needle intravenous catheter into the prepped area where the fluid is available for sampling safely. The patient can be standing or be placed in left or right lateral recumbency. Be sure to avoid iatrogenic puncture of any intraabdominal organs. Fluid may passively flow out from the hub of the needle or intravenous catheter. Attach a 3 or 6 ml syringe and gently aspirate the fluid to obtain and save a sample for analysis later on. Alternatively, you may also have the syringe pre-attached to the needle to sample the fluid if you forgo using the intravenous catheter. Once you’ve obtained the desired amount of fluid, carefully remove the needle or intravenous catheter from the abdominal cavity and apply pressure to the point of entry with clean gauze for 3 to 5 minutes
Abdominocentesis
If the removal of a larger amount of free fluid from the abdomen is indicated, up to a 14 gauge over-the-needle intravenous catheter may be used to aide in the process. Prep the area as outlined above. Prior to entry into the abdomen, remove the end cap of the catheter in order to observe a flashback of fluid as you advance the needle. Once a flash is obtained, carefully advance the catheter over the needle into the abdomen. Discard the needle appropriately and attach an IV extension set to the end of the catheter with the distal end of the extension set draining into a clean bowl or graduated cylinder. Fluid can be removed passively with the help of gravity or via a 3 way stopcock and syringe. Once the desired amount of fluid is withdrawn, carefully remove the intravenous catheter from the abdominal cavity and apply pressure to the point of entry with clean gauze for 3 to 5 minutes. Alternatively, some doctors have attached active suction for larger volumes of fluid removal. Performing abominocentesis may be contraindicated in some patients due to prolonged coagulation factors or low platelets. Problems may also arise if too much fluid is removed at once. In right-sided heart failure cases especially, the goal of this treatment may only be removing enough fluid from the abdomen in order for the patient to breath more comfortably
Sample Storage
Store the sample in a sterile glass red top tube and a lavender top EDTA tube. Typically, samples will not clot. If the sample does clot, active hemorrhage may be occurring and emergency surgery may be required. Alternatively, iatrogenic puncture of an internal organ may have occurred. Samples saved in these tubes may easily be prepped for microscopic examination later on. They may also be placed in hematocrit tubes and then spun down in a centrifuge to determine the packed cell volume and total protein level. A sample can be saved in a green top tube as well, such as lithium heparin, for evaluation of certain electrolyte and biochemistry values. For example, clinicians will run these samples through their electrolyte and biochemistry blood analyzers to help diagnose certain conditions such as a uroabdomen. In these cases, they will compare the creatinine or potassium levels of the fluid sampled to that of the blood
Aseptically clip and scrub the desired sampling area with the proper antimicrobial solution. Doing so greatly reduces the risk of infection. Ultrasonography can be used to observe the best area for sampling. Samples may be otherwise likely be obtained 1 to 2 cm caudal to the umbilicus on midline when an ultrasound is unavailable. Skin blocks and/or sedation can be used on a patient to patient basis
Obtaining a Diagnostic Sample
Wearing gloves, carefully insert a 22 or 20 gauge needle or over-the-needle intravenous catheter into the prepped area where the fluid is available for sampling safely. The patient can be standing or be placed in left or right lateral recumbency. Be sure to avoid iatrogenic puncture of any intraabdominal organs. Fluid may passively flow out from the hub of the needle or intravenous catheter. Attach a 3 or 6 ml syringe and gently aspirate the fluid to obtain and save a sample for analysis later on. Alternatively, you may also have the syringe pre-attached to the needle to sample the fluid if you forgo using the intravenous catheter. Once you’ve obtained the desired amount of fluid, carefully remove the needle or intravenous catheter from the abdominal cavity and apply pressure to the point of entry with clean gauze for 3 to 5 minutes
Abdominocentesis
If the removal of a larger amount of free fluid from the abdomen is indicated, up to a 14 gauge over-the-needle intravenous catheter may be used to aide in the process. Prep the area as outlined above. Prior to entry into the abdomen, remove the end cap of the catheter in order to observe a flashback of fluid as you advance the needle. Once a flash is obtained, carefully advance the catheter over the needle into the abdomen. Discard the needle appropriately and attach an IV extension set to the end of the catheter with the distal end of the extension set draining into a clean bowl or graduated cylinder. Fluid can be removed passively with the help of gravity or via a 3 way stopcock and syringe. Once the desired amount of fluid is withdrawn, carefully remove the intravenous catheter from the abdominal cavity and apply pressure to the point of entry with clean gauze for 3 to 5 minutes. Alternatively, some doctors have attached active suction for larger volumes of fluid removal. Performing abominocentesis may be contraindicated in some patients due to prolonged coagulation factors or low platelets. Problems may also arise if too much fluid is removed at once. In right-sided heart failure cases especially, the goal of this treatment may only be removing enough fluid from the abdomen in order for the patient to breath more comfortably
Sample Storage
Store the sample in a sterile glass red top tube and a lavender top EDTA tube. Typically, samples will not clot. If the sample does clot, active hemorrhage may be occurring and emergency surgery may be required. Alternatively, iatrogenic puncture of an internal organ may have occurred. Samples saved in these tubes may easily be prepped for microscopic examination later on. They may also be placed in hematocrit tubes and then spun down in a centrifuge to determine the packed cell volume and total protein level. A sample can be saved in a green top tube as well, such as lithium heparin, for evaluation of certain electrolyte and biochemistry values. For example, clinicians will run these samples through their electrolyte and biochemistry blood analyzers to help diagnose certain conditions such as a uroabdomen. In these cases, they will compare the creatinine or potassium levels of the fluid sampled to that of the blood
Sources:
Durham, H. Edward. "Body Cavity Centesis: Techniques for the Pleural, Abdominal, and Pericardial Cavities." Today's Veterinary Nurse, Mar. 2017, https://todaysveterinarynurse.com/articles/body-cavity-centesis-techniques-for-the-pleural-abdominal-and-pericardial-cavities/
Ford, Richard B., and Elisa M. Mazzaferro. Kirk and Bistner's Handbook of Veterinary Procedures and Emergency Treatment. 8th ed., Saunders Elsevier, 2006.
On The Job Training and Routine Practices
Durham, H. Edward. "Body Cavity Centesis: Techniques for the Pleural, Abdominal, and Pericardial Cavities." Today's Veterinary Nurse, Mar. 2017, https://todaysveterinarynurse.com/articles/body-cavity-centesis-techniques-for-the-pleural-abdominal-and-pericardial-cavities/
Ford, Richard B., and Elisa M. Mazzaferro. Kirk and Bistner's Handbook of Veterinary Procedures and Emergency Treatment. 8th ed., Saunders Elsevier, 2006.
On The Job Training and Routine Practices