Report sudden hypotension, tachycardia, dizziness, or pallor indicating hypovolemic shock from fluid shift.
Before you read
Test yourself first: 2 questions
Question 1 of 2
A client with cirrhosis is scheduled for a paracentesis to relieve ascites. Which nursing action is essential immediately before the procedure?
Answer: A. Having the client empty the bladder before paracentesis prevents accidental puncture of a full bladder when the needle is introduced into the abdomen. The nurse also obtains baseline vital signs and weight. The client does not need to be NPO for a routine paracentesis, is positioned upright or with the head elevated rather than prone, and large-volume fluids are not forced beforehand.
Question 2 of 2
A client with cirrhosis develops abdominal pain, fever, and worsening ascites. Spontaneous bacterial peritonitis is suspected. Which diagnostic test should the nurse anticipate?
Answer: A. Spontaneous bacterial peritonitis is diagnosed by sampling the ascitic fluid, so the nurse anticipates a diagnostic paracentesis with cell count and culture of the fluid; a high neutrophil count in the ascitic fluid confirms infection. A barium swallow, colonoscopy, and skin biopsy do not evaluate ascitic fluid infection.
Keep the streak going with more questions like these, each with a full rationale.
What is paracentesis?
It relieves dyspnea, abdominal pressure, and discomfort caused by fluid accumulation. Memory aid: PARA = pull abdominal-fluid; pee first to protect the bladder.
Key points to remember
- The patient must void immediately before the procedure to empty the bladder and prevent accidental puncture.
- Position the patient upright (high Fowler's or sitting at the edge of the bed) so fluid pools low and the bowel floats away from the needle.
- Removing large volumes (more than 4-6 liters) can cause hypovolemia and hypotension from fluid shifting back into the peritoneal space.
- Albumin (a colloid volume expander) is often given when large amounts of fluid are removed to prevent circulatory dysfunction.
- The site is below the umbilicus and the procedure is done with sterile technique under local anesthetic.
- Fluid is sent for cell count, culture, albumin, and protein to assess for spontaneous bacterial peritonitis.
Nursing priorities
- Obtain baseline weight, abdominal girth, and vital signs, and verify a signed informed consent.
- Have the patient void or insert a catheter to empty the bladder before the tap.
- Monitor vital signs frequently during and after for hypotension and tachycardia signaling hypovolemia.
- Measure, describe, and document fluid amount, color, and characteristics, and send specimens to the lab.
- After the procedure, apply a dressing, monitor the site for leakage, and recheck weight and girth.
Labs & values
Patient teaching
- Empty your bladder right before the procedure to keep it safe.
- Tell the nurse if you feel lightheaded, dizzy, or short of breath afterward.
- Report any fluid leaking from the puncture site once you are home.
- Some pressure or a tugging sensation is normal, but sharp pain is not.
Red flags: report now
- Report sudden hypotension, tachycardia, dizziness, or pallor indicating hypovolemic shock from fluid shift.
- Report fever, increasing abdominal pain, or cloudy fluid suggesting peritonitis.
- Report persistent fluid leakage, frank bleeding, or hematuria after the procedure.
- Never proceed without confirming the bladder is empty.
References
Clinical references for this topic
