Abdominal paracentesis

In June 2023, we commenced a project to review and update the Maternity and Neonatal eHandbook guidelines with a view to completion in 2024. Please be aware that pending this review, some of the current guidelines may be out of date. In the meantime, we recommend that you also refer to more contemporaneous evidence.

Abdominal paracentesis is a medical procedure where the abdominal cavity is punctured to obtain fluid for therapeutic or diagnostic purposes.

This procedure should only be used for an infant in extremis (such as hydrops fetalis) and performed by a senior clinician in a non tertiary special care nursery (SCN).

Procedure

Consider the need for pain relief including:

• oral sucrose for procedural pain
• subcutaneous lignocaine infiltration
• intravenous morphine infusion.

Precautions:

• Abdominal ultrasound examination should be performed  to determine the appropriate site for paracentesis; this may not be practical in resuscitation settings.
• 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:

1. Aseptic technique - scrub, gown and glove.
2. Prepare skin, allowing solution to dry.
3. Insert local anaesthetic solution.
4. Attach needle or IV cannula to three-way tap.
5. Attach three way tap to 10 or 30 mL syringe (in continuity).
6. Ensure three way tap is 'on' to baby and syringe.
7. 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. 
8. Slowly advance needle or cannula while gently aspirating syringe.
9. Stop when fluid obtained. If using IV cannula, push catheter off needle.
10. Remove stylet, connecting syringe via three way tap to catheter.
11. Aspirate desired amount of fluid:
    • Volume should be < 2 per cent of (estimated) body weight
12. Remove needle/cannula, applying firm pressure to site until ooze stops.
13. Apply adhesive dressing.
14. Monitor haemodynamic parameters and urine output closely as fluid shift may occur.