Healthcare and Medicine Reference
In-Depth Information
(a)
(b)
(c)
(d)
Figure 8.4 Step-by-step guide: ascitic tap. (a) Cleaning the area (2% chlorhexidine in 70% alcohol). (b) Infi ltration of local anaesthetic. (c) Aspirating whilst
advancing the green needle. (d) Successful aspiration of peritoneal fl uid (the needle is not advanced any further).
4
Infi ltrate the skin at the chosen site with local anaesthetic (e.g. 1% lido-
Table 8.1 Samples required from diagnostic tap.
caine), using an orange needle and 10-mL syringe (Figure 8.4b).
Use a green needle to infi ltrate the deeper subcutaneous tissues;
Specimen
Tests requested
5
a 'fl ashback' of ascitic fl uid will occur when the peritoneal space
is reached.
Using a green needle and 20-mL syringe, insert the needle
Biochemistry
Universal container
Fluid protein
Fluid albumin
6
Microbiology
Sterile universal container (for Gram
stain and cell count)
Blood culture bottles (for culture and
sensitivities)
EDTA blood tube (for cell count if
sample heavily bloodstained)
M, C and S
Cell count
perpendicular to the skin and slowly advance. Aspirate gen-
tly as you advance the needle until fl uid can be easily aspirated
(Figure 8.4c).
Aspirate 20 mL fl uid and withdraw the needle (Figure 8.4d).
7
8
Apply pressure to the site and cover with an adhesive dressing.
Cytology
Universal container
Cytology
9
Distribute the aspirate into the containers described in Table 8.1,
ensuring sterility throughout.
M, C and S, microscopy, cultures and sensitivities.
Analysis of ascitic fl uid
infection. Transudates result from reduced plasma oncotic pressure
or increased plasma hydrostatic pressure:
total protein concentration: transudate <30 g/L; exudate >30 g/L.
Biochemistry
Fluid protein and fl uid albumin concentrations will identify
the fl uid as either a transudate or exudate. Exudates are usu-
ally caused by infl ammatory conditions such as malignancy and
Total protein concentration alone is an unreliable method as,
for example, cardiac ascites may have a high protein content,
 
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