140 Section IV ■ Miscellaneous Sampling

retract the skin in a downward direction while advancing the needle to create a Z-track after removal of the

needle and catheter.

8. Push the catheter and needle through the skin, muscles, and peritoneal surface while applying gentle suction on the syringe plunger.

9. When a sudden decrease in resistance is felt and peritoneal fluid is aspirated, withdraw the needle and advance

the catheter.

10. Connect an extension tube with a three-way stopcock

to the syringe and apply gentle, intermittent suction to

aspirate as much fluid as possible.

11. If fluid is not free-flowing, the catheter might be inside

the intestinal lumen or in the retroperitoneum.

Withdraw the catheter, and repeat the maneuver with

the catheter at a slightly different angle. Alternatively,

reposition the patient carefully to maintain the catheter

site in the dependent position to continue fluid aspiration.

12. When the fluid stops flowing, withdraw the catheter.

13. Distribute the fluid into the various tubes and cups for

the appropriate studies.

14. Apply a bandage, holding pressure until leaking has

stopped.

E. Complications

1. Bleeding from the liver or intra-abdominal vessels:

May be severe enough to require a laparotomy

2. Intestinal perforation: May lead to abdominal sepsis;

however, it is more commonly inconsequential because

the catheter and needle are of small diameter. Risk may

be reduced with nasogastric or rectal tube decompression

if intestinal distension is significant prior to procedure.

3. Hypotension: May be due to sudden large fluid shifts

during therapeutic paracentesis. Patients should be

placed on a monitor during the procedure, and fluid

should be withdrawn slowly.

4. Hematoma: Take care to avoid the inferior epigastric

vessels.

5. Scrotal or labial edema: Due to tracking of fluid

between layers of the abdominal wall

6. Persistent ascitic fluid leak: May require suture closure or bag drainage to prevent skin maceration

References

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infants with necrotizing enterocolitis. Am Surg. 1986;52(2):61.

2. Rees CM, Eaton S, Pierro A. National prospective surveillance

study of necrotizing enterocolitis in neonatal intensive care units.

J Pediatr Surg. 2010;45:1391.

3. Sabri M, Saps M, Peters JM. Pathophysiology and management of

pediatric ascites. Curr Gastroenterol Rep. 2003;5:240.

4. Vieira SMG, Matte U, Kieling CO, et al. Infected and noninfected ascites in pediatric patients. J Pediatr Gastroentrol Nutr.

2005;40(3):289.

5. Fitzgerald JF. Ascites. In: Wyllie R, Hyams JS, ed. Pediatric

Gastrointestinal Disease: Pathophysiology, Diagnosis, Management.

1st ed. Philadelphia: WB Saunders; 1993:1510.

6. Oei J, Garvey PA, Rosenberg AR. The diagnosis and management

of neonatal urinary ascites. J Paediatr Child Health. 2001;37(5):513.

7. Shyu MK, Shih JC, Lee CN, et al. Correlation of prenatal ultrasound and postnatal outcome in meconium peritonitis. Fetal

Diagn Ther. 2003;18(4):255.

8. Saps M, Slivka A, Khan S, et al. Pancreatic ascites in an infant: Lack

of symptoms and normal amylase. Dig Dis Sci. 2003;48(9):1701.

9. Nicol KK, Geisinger KR. Congenital toxoplasmosis: diagnosis by

exfoliative cytology. Diagn Cytopathol. 1998;18:357.

10. Lemyre E, Russo P, Melancon SB, et al. Clinical spectrum of infantile free sialic acid storage disease. Am J Med Genet. 1999;82:385.

11. Grabau CM, Crago SF, Hoff LK, et al. Performance standards for

Fig. 26.2. Entry site and direction of needle for abdominal therapeutic abdominal paracentesis. Hepatology. 2004;40:484.

paracentesis in preterm neonate.

Fig. 26.1. Appropriate position and disinfection of abdomen

prior to performing paracentesis in preterm neonate.