Paracenthesis at the bedside

NurseKatie08, MSN · Jan 31, 2015

On my floor we do both diagnostic and therapeutic paracentesis at the bedside. Typically the nurses have little to do with it unless the doc asks for an assist. I work on a pre/post liver transplant floor, so it's a pretty commonplace procedure for us. Occasionally people do go to IR for a para as well.

kool-aide, RN · Jan 31, 2015

We always stay at the bedside, the md may not, depending on the situation.

ixchel · Jan 31, 2015

Are you saying as an RN, you are doing the procedure, sometimes without the MD present? I didn't know that was even within an RN's scope of practice. The MDs do them at my facility.

RescueNinjaKy · Jan 31, 2015

Look at your facility's policies and your state's board of nursing

nurseprnRN, BSN, RN · Feb 1, 2015

Inserting the paracentesis cath is not within the nursing scope of practice, so the MD would do that. There's no reason for the MD to stay at bedside once the catheter is safely in place. There should definitely be a nurse at the bedside, though, to monitor for evidence of sudden fluid shifts, bleeding, perforation, etc., but it can take a long, uneventful time to drain (or even leave the cath in for days, for rapid re-accumulation) and there's no need to have the MD there. Or am I misunderstanding what you're asking?

jadelpn, LPN, EMT-B · Feb 2, 2015

There are a couple of different scenarios. But always check with your facility policy.

A therapeutic (acute--or sub acute if done regularly and PRN) paracentesis is done by an MD. That is where a cath is introduced and bottles are filled (and in some facilities it is a container to hand maneuvered suction. The MD stays at bedside, due to the MD deciding how much fluid they are going to draw off. Sometimes a patient can not tolerated more than "X" amount of liters, and that is an MD decision.

A different scenario is a patient who has an indwelling cath, for chronic conditions that require sometimes daily draining--Typically, these patients come in on an outpatient basis to have the dressing changed on said cath site, as well as vacuum bottles that some patients would do at home, others come in as an outpatient to have their acities drained. That usually has an MD order, and can be done in SOME FACILITIES (again, check your policies) by a nurse. This is mostly found in long term palliative care patients, end stage liver disease, that kind of thing.

Just be really mindful and careful in the aftermath that patient is not exhibiting signs of fluid depletion if MD is aggressively drawing off liters and liters. And in the second scenario that the patient is not aggressively pulling off too much--it is important if the patient is coming in as an outpatient that they are able to again function at home if that is the goal.

Best wishes!

enchantmentdis, BSN, RN · Feb 8, 2015

If the patient already has an access device in place, in hospice we as nurses are able to connect a drainage kit to it and remove 1,000 mls once per week. Any more than that is prohibited.

melizerd, ASN, RN · Feb 8, 2015

MD would do this and the Rn would assist. Mostly we sent patients to IR but there are a few docs that do it bedside.

I'm on a med/surg oncology floor.

allnurses Guide · Feb 18, 2015

In the ER, the MD puts it in and the nurse monitors. We don't stay in the room, but we do change over to the next bottle when the first, second, third and occasionally fourth evacutaner is full. They are on a monitor with frequent BP checks.

icuRNmaggie, BSN, RN · Mar 4, 2015

Try googling Pleurx catheters. These are inserted in Interventional Radiology for frequent drainage of pleural effusions or ascitic fluid.

There is a specific technique for attaching the pleurx catheter to the negative pressure one liter plastic containers. An order is required specifying the amount to be removed. The physician does not need to be present when draining ascitic fluid

This is mainly done as a comfort measure in end stage liver disease.