Practice Guidelines for Large Volume Paracentesis

I cannot seem to find any nursing practice guidelines on large volume paracentesis. I have not done paracentesis in years and it was just a few liters. Does anyone have resources they would like to share?

[firstinfamily, RN]

Is there anything in Lippincott's most recent edition of Nursing Practice?? Does your facility have a policy, protocol defined in the nursing P&P book?

[tyvin, BSN, RN]

I didn't know RNs could perform Paracentesis on a patient?

[applewhitern, BSN, RN]

Me, too, tyvin. I have never known anyone but an MD to perform a paracentesis on a patient. I have known them to draw off huge quantities of fluid at one time, but I am not aware of any protocol, other than pain control and possibly replacing albumin, and of course, consent.

[TravelingirlRN]

I don't have the most recent Lippincott and the one I have only discusses regular paracentesis. I am really interested in the large volume..over 5L at a time. I cannot find any guidelines at my facility.

[TravelingirlRN]

Right, nurses don't initiate the paracentesis but we do monitor the patient and change the canisters. So I am looking for nursing considerations during and after paracentesis, specifically large volume paracentesis. I guess I should have clarified that. Thanks!

[TravelingirlRN]

Right..we don't perform it but we monitor and change canisters. I am looking for large volume paracentesis nursing considerations. I am only used to a couple liters but it seems much greater volumes are being taken off these days. The only literature I have found is really for physicians and practice.

[TU RN]

Generally large volume paracentecis (5-10L) is followed up by albumin administration. I've seen STAT 25 gram infusions after the procedure as well as additional 25 gram doses 12 hours later. I couldn't find nursing practice guidelines as it isn't really a "nursing" practice.

No nurse should ever be performing a paracentecis except maybe (and that's a HUGE maybe) an experienced, trained, in-some-way credentialed APRN. This medical procedure involves the introduction of a large needle into the peritoneal cavity (see: kidneys, bladder, intestines, liver, stomach, spleen, abdominal aorta, mesenteric vasculature, lung bases) generally for a patient with profound ascites. Often this patient will have formed ascites secondary to hepatic cirrhosis and has abnormal coagulation as well, making such an invasive procedure especially dangerous. Physicians carry the knowledge and skill (oh, and massive Liability Insurance policies) for performing paracenteces so just leave it to them.

Sorry I didn't see you had posted your responses until after I posted my rant

[TravelingirlRN]

Has anyone seen this in outpatient therapy with Interventional radiology? I guess my question is really...what should be the nurses role in this procedure and is the physician usually present during the entire procedure?

[tyvin, BSN, RN]

If you do a search on this site there are a few posts about your topic. I would think the best place to get the info you seek is from doctors since it's not a nursing procedure. RNs assist with all kind of procedures and it's usually the doc who orders equipment to their specifications and likes with invasive procedures; the kits etc..., etc... . It also would include what p/p the facility requires per procedure of this and that.

I'm curious as to why don't you Google search or what ever search engine strikes your fancy, the non-nursing protocol you seek and than come on and tell us what you find. It appears you are asking for advice about procedures that are out of the RNs scope of practice.

[TravelingirlRN]

I have google searched but am only finding physician stuff. I am looking for info on nurse roles/considerations while assisting. The p/p I have is vague so I am looking for more info. It would be analogous to a chest tube....I don't perform the chest tube but I monitor it. I did see one other post but it was 6 years ago so I was hoping for more.

[Esme12, ASN, BSN, RN]

Right..we don't perform it but we monitor and change canisters. I am looking for large volume paracentesis nursing considerations. I am only used to a couple liters but it seems much greater volumes are being taken off these days. The only literature I have found is really for physicians and practice.

http://www.medscape.com/viewarticle/714698

medscape.....requires registration but free....Medscape: Medscape Access

Albumin Calculator (adult dosing), hypovolemic, hypovolemia, paracentesis

Nursing Center - CE Article