Abdominal Paracentesis

this should only be performed in a level 2 SCN as a therapeutic manoeuvre for an infant in extremis (hydrops foetalis)
it should only be undertaken by the most senior clinician available

Equipment for abdominal paracentesis includes

Consider the need for pain relief including
- oral sucrose (link to section)
- subcutaneous lignocaine infiltration
- intravenous morphine infusion
Precautions
- abdominal ultrasound examination may be helpful in determining the appropriate site for paracentesis
- ensure that the bladder is empty before paracentesis using midline route
- care should be taken to avoid any distended abdominal vessels
- coagulopathies or thrombocytopenia do not contraindicate procedure
The procedure is as follows
- aseptic technique - scrub, gown and glove
- prepare skin, allowing solution to dry
- insert local anaesthetic solution
- attach needle or IV cannula to three way tap
- attach three way tap to 10 ml or 30 ml syringe (in continuity)
- ensure three way tap is 'on' to baby and syringe
- insert needle or IV cannula
  - either in midline halfway between the umbilicus and the symphysis pubis
  - or in either lower quadrant several centimeters above the inguinal ligament, lateral to the rectus muscle and in a line with the nipples
- slowly advance needle or cannula whilst gently aspirating syringe
- stop when fluid obtained. If using IV cannula, push catheter off needle
- remove stylet, connecting syringe via three way tap to catheter
- aspirate desired amount of fluid
  - may be 100-200 ml
  - should be <2% of (estimated) body weight
- remove needle/cannula, applying firm pressure to site until ooze stops
- apply adhesive dressing

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