Permanent Paracentisis Sites

leslie :-D · Jan 21, 2005

i've never heard of permanent paracentesis sites....i always thought the md did it at the bedside using a large guage needle. this is someting new to me.

as for catheters getting clogged, if continuous irrigation or a larger size catheter doesn't work then i'm at a loss.

of course you want to r/o infection which could leave alot of sediment in the urine.

sorry couldn't be more help.

leslie

Pediatric Critical Care Columnist · Jan 21, 2005

I've seen a couple of ways to do multiple paracentesis. When my son was in PICU after his liver transplant and was in MODS, he was needing them several times a day. One of the resident physicians cobbled together a system that allowed for a single puncture and multiple drain cycles. He used a long 18g angiocath to access the fluid pocket and then sutured it to the skin. A stopcock, some IV tubing and an empty 5L dialysate bag were the collection system. The stopcock was attached to the hub of the angiocath, the tubing to the stopcock and the bag to the tubing. The tubing was taped to his abdomen, the bag placed on a blue pad on a footstool under the bed. When the ascites built up to the needs-to-be-drained-now stage, the stopcock would be open and the fluid would run out into the bag. The other way to drain off accumulating fluid is to place a Tenckhoff catheter (used for peritoneal dialysis) which can be opened and closed as often as needed. It's simply attached to a urine collection set. But this approach requires surgical intervention.

The only cure I know of for frequently-blocked Foleys is to irrigate it regularly. Or else change it. Irrigation is more cost effective.

aimeee, BSN, RN · Jan 25, 2005

I was talking to a rep about the pleurx catheter and I believed he mentioned that there has been some use of them for those who need abdominal drainage. At >$50 a pop, its not a cheap option, but it is simple to use and something patient/family can handle themselves.

http://www.jvir.org/cgi/content/abstract/12/3/373

http://www.denverbio.com/physician_pleurx_catheter.html

aimeee, BSN, RN · Jan 25, 2005

I was talking to a rep about the pleurx catheter and I believed he mentioned that there has been some use of them for those who need abdominal drainage. At >$50 a pop, its not a cheap option, but it is simple to use and something patient/family can handle themselves.

http://www.jvir.org/cgi/content/abstract/12/3/373

http://www.denverbio.com/physician_pleurx_catheter.html

Home Health Columnist / Guide · Jan 26, 2005

1. We've got a couple of patients that are getting abdominal centesis every week or so. This can be pretty time consuming and stressful to the patient/family.
We were wondering of anyone uses a permanent indwelling drain. something that could be accessed 'at home', by the nurse and drained prn?
2. Was told there are some urinary catheters that are impregnated with an antibacterial solution to minimize UTIs in patients that have long term catheters.
In the same topic does anyone have suggestions for patients that catheters that continually clog with sediment?

1. I have info at my office + nursing procedure for home paracentesis drainage via type of dialysis catheter (forget name)---will post tomorrow.

Tenkoff catheter--- I think.

2. Silicone catheters are recomended for clients with long term catheter use.

3.Frequent cloging: Increase fluid intake if on on restriction. Some people do well with unsweetened cranberry juice; cranberry capsules have better effect without sugar content. Irrigation with acetic acid or just nss helps some people.

Frequent postition change, keeping catheter bag below bladder level and emptying when 1/2 full also help prevent urine stagnation in bladder outlet.

Home Health Columnist / Guide · Jan 26, 2005

1. We've got a couple of patients that are getting abdominal centesis every week or so. This can be pretty time consuming and stressful to the patient/family.
We were wondering of anyone uses a permanent indwelling drain. something that could be accessed 'at home', by the nurse and drained prn?
2. Was told there are some urinary catheters that are impregnated with an antibacterial solution to minimize UTIs in patients that have long term catheters.
In the same topic does anyone have suggestions for patients that catheters that continually clog with sediment?

1. I have info at my office + nursing procedure for home paracentesis drainage via type of dialysis catheter (forget name)---will post tomorrow.

Tenkoff catheter--- I think.

2. Silicone catheters are recomended for clients with long term catheter use.

3.Frequent cloging: Increase fluid intake if on on restriction. Some people do well with unsweetened cranberry juice; cranberry capsules have better effect without sugar content. Irrigation with acetic acid or just nss helps some people.

Frequent postition change, keeping catheter bag below bladder level and emptying when 1/2 full also help prevent urine stagnation in bladder outlet.

Home Health Columnist / Guide · Jan 26, 2005

two good books by diane kaschak newman, incontinence np:

the urinary incontinence sourcebook

managing and treating urinary incontinence

Home Health Columnist / Guide · Jan 26, 2005

two good books by diane kaschak newman, incontinence np:

the urinary incontinence sourcebook

managing and treating urinary incontinence

Valorie D · Jan 26, 2005

Some really good information.

Thanks so much. :)Val

skd1019 · Feb 7, 2005

Just last month I sent a patient out to a local hospital to have a catheter implanted for paracentesis. It is a type of dialysis catheter, although the record I received from the O.R. (outpatient surgery) when my patient returned didn't give a specific name (simply referred to it as a "65cm pig-tail dialysis catheter") It is a simple tube with a clamp near the end, and a small cap at the tip. Every other day we attach a foley bag, and allow it to drain for 1 hour. It is very simple to use. I should also mention that we had a bit of difficulty finding a surgeon to do the procedure. However, being able to spare the patient from having to be tapped Q6days was well worth the effort. Hope this helps.

Home Health Columnist / Guide · Feb 15, 2005

guidelines for ascites drainage using tenkoff catheter

for homecare patients

procedure reviewed with ursella rn, hahneuman univ. transplant clinical educator

gather supplies: masks, dressings, paracentesis tray, gloves, tape etc.

sterile procedure to be followed during procedure.

patient, rn and caregiver in immediate area to wear masks.
patient / rn wash hands using antimicrobial soap using surgical scrub technique
surgical prep skin area and catheter exit site/cap for minimum of one minute w/betadine. (use hibiclens/accept solution if betadine allergy)
prepare sterile field. open paracentesis tray, attach paracentesis tubing to 2 liter drainage bag.
insert needle connection into huber cap of catheter. open tenkoff catheter clamp to allow gravity drainage of fluid into bag. record amount of drainage and fluid characteristics, any symptoms reported by patient. report any signs and symptoms of infection to physician.
close clamp. disconnect + dispose of needle/tubing in sharps type container.
dispose of ascites fluid into toilet.
apply dsd to catheter exit site-patient to change daily prn.
goal is to have patient/caregiver perform procedure independently.
weights not indicated at this time.

see article:

malignant ovarian ascites can be draining

marylisa kissinger, rn, bsn

[color=#c0c0c0]nursing spectrum masthead date august 25, 2003

http://community.nursingspectrum.com/magazinearticles/article.cfm?aid=10277