Paracentesis

Equipment

• Lidocaine with epi
• chlorhexidine
• Paracentesis kit (catheter, 11 blade, syringes, bandaid)
• Ultrasound
• Vacuumed bottles

Procedure

Placing Cx in BCx tube increases yield

Workup

1. Cell count with dif
2. Cx (BCx bottles)
3. Grm stain

Consider:

1. Albumin and SERUM albumin
2. Protein
3. Glucose
4. LDH and SERUM LDH at same time
5. Amylase

Specific circumstances:

1. TB smear and Cx
2. Cytology
3. TG
4. Billirubin

Diagnosis

SBP

Any:

1. >500 WBC
2. >250 PMNs
3. Positive gm stain (single microbe)

^For bloody tap, subtract 1 WBC for every 250 RBC

Consider Peritonitis (eg. perf appy, chole)

Any:

1. >10,000 WBC
2. Polymicrobial gm stain
3. Total protein >1g/dL
4. Glu <50
5. Increased LDH

If on Peritoneal Dialysis

SBP if: 1) >100WBC OR >50% NEUT

If on Nightly APD

SBP if:

1. >50%NEUT
2. Amyase (>100 suggestive of intra-abd process)

See Also

Spontaneous Bacterial Peritonitis (SBP)

Source

12/06 DONALDSON