A patient of cirrhosis comes with massive ascites and a therapeutic drainage of the ascetic fluid is planned. What should be the correct statement?

Appeared in: RML Lucknow - 2021

Explanation

The Z-technique is the standard of care for large-volume paracentesis to minimize complications.
It involves displacing the skin before needle insertion, creating a non-linear, staggered path.
When the needle is withdrawn and the skin is released, the layers of tissue slide back into place, sealing the tract.
This mechanism effectively prevents the persistent leakage of ascitic fluid from the puncture site, which is a common post-procedure issue.

Option A: A simple perpendicular insertion without the Z-technique creates a direct channel from the peritoneum to the skin, increasing the risk of persistent fluid leakage after the catheter is removed.
Option C: A 23-gauge needle has a very small bore, which would make the drainage of massive ascites extremely slow and inefficient. It is not suitable for therapeutic (large-volume) removal.
Option D: The lumbar region (back) is an anatomically incorrect and dangerous site for abdominal paracentesis. This area contains the spine, spinal nerves, and major retroperitoneal vessels and muscles.

Clinical Relevance

Nursing practice connection: Use the key finding related to Therapeutic Paracentesis Procedure to guide bedside assessment, documentation, and the next nursing action.
A key nursing responsibility during paracentesis is monitoring for post-paracentesis circulatory dysfunction (PPCD), a form of hypovolemia that can occur after rapid removal of large fluid volumes. This is why frequent vital sign monitoring (especially blood pressure) is critical.
Nurses must ensure the patient has voided immediately before the procedure to reduce the risk of accidental bladder perforation, a serious complication.
What if the patient has multiple abdominal surgical scars? The nurse should anticipate the need for ultrasound guidance to select a safe puncture site, as scars can indicate underlying adhesions or altered anatomy, increasing the risk of bowel perforation.

How to Approach the Question

First, identify the core procedure in the question: therapeutic drainage of ascitic fluid (paracentesis).
Recall the standard protocol and key safety steps for this procedure. Think about site, equipment, technique, and potential complications.
Evaluate each option against this standard protocol.
Option A (perpendicular insertion): Is this the most important part of the technique? It's an incomplete statement and can be risky without the Z-track.
Option B (Z-technique): Does this technique address a major goal or prevent a common complication? Yes, it prevents fluid leakage.
Option C (23 gauge): Is this the right equipment for removing a 'massive' amount of fluid? No, it's too small.

Concept Tested & Keywords

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) pp. 782-784, 783-785

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