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(f )
Figure 16.2 Step-by-step guide: insertion of ascitic drain. (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). (e) Making a
small incision. (f) Aspirating whilst advancing the catheter. (g) Flashback of
peritoneal fl uid. (h) Sliding the catheter over the needle. (i) Checking the
position of the catheter once fully advanced (can still aspirate peritoneal
fl uid). (j) Catheter sutured in position.
Identify the catheter insertion site, preferably in the left lower
Use a 21G green needle to inoculate lidocaine into the skin, sub-
Wash hands thoroughly and don a sterile gown and gloves,
cutaneous tissues, muscles and parietal peritoneum. Maintain
the needle perpendicular to the abdominal wall at all times
(Figure 16.2b,c).
Note the depth at which the peritoneum is entered (when ascites
considering also personal protective equipment.
Cleanse with antiseptic solution (e.g. 2% chlorhexidine in 70%
alcohol) and drape the area with sterile towels (Figure 16.2a).
Take 10 mL of 1 or 2% lidocaine in a 10-mL syringe. Using a
can be aspirated back into the syringe). You must always be able
to drain ascites with the green needle and syringe before insert-
ing the peritoneal catheter and note the depth at which perito-
neum is reached (Figure 16.2d).
25G orange needle, raise a small skin bleb around the skin
entry site.
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