When ascites is diagnosed, a perforation of the peritoneal wall and sampling of the liquid for analysis is a mandatory procedure. It is used to study ultrafiltrate and perform drainage( evacuation) in ascites. There are contraindications to puncture: laparocentesis in ascites can not be performed if the patient has an adhesive process of organs located in the abdominal cavity, with a pronounced meteorism, with the possibility of damage to the intestinal wall, tumors, development of purulent processes in the described area.
Like any other operation, laparocentesis( puncture) takes place in several stages. The patient is first prepared for the procedure: it is necessary to clean the intestines and empty the bladder. If the diagnosis is confirmed, the operation to remove ascites is carried out under local anesthesia with the use of a single tool - the trocar, whose end is strongly pointed. In the kit comes a polyvinylchloride tube, which is used to puncture ascites and a special clamp.
Technique for performing laparocentesis with ascites
When the removal of ascites( paracentesis) is performed, the patient usually sits, while in other surgical operations using endoscopic equipment the patient is placed in a position lying on his back.
- The incision( puncture) is done on the abdominal line at a distance of 2-3 cm from the navel line. Previously, the surgeon polishes the puncture site with antiseptics.
- He then produces a layered infiltration of tissues near the puncture site with solutions of ice-cain 2% or novocaine 1%.
- After anesthesia with a scalpel, the skin, subcutaneous tissue and peritoneum muscles are cut, puncture( paracentesis) should provide a notch with a diameter slightly wider than the diameter of the instrument used in carrying out the laparocentesis, but do not pierce the skin right through. The task of the surgeon is to make a dosed cut-puncture, which affects only the upper layers of the skin.
- To accidentally not damage the intestine with a catheter tube, laparocentesis and puncture are performed using ultrasound or special attachments - devices that make a safe channel free of the bowel loops.
- The trocar is taken into the hands, and the final one is already performed - a puncture of the abdominal cavity in ascites with rotational movements. Troakar looks like a stylet. Inside it there is a space where a polyvinylchloride tube is inserted, through which puncture is performed.
- If the trocar was inserted correctly, the liquid must leak out. When the trickle has flowed after the puncture, the tube can be pierced inwards for another 2-3 cm. This is done so that the end of the polyvinylchloride tube does not move toward the soft tissues during the long pumping of ascitic fluid.
- The tube is first punctured, and then excess water is removed( pumping out is very slow, about a liter in five minutes, focusing on the patient's condition during the operation).Today, laparocentesis of the abdominal cavity with ascites can remove up to 10 liters at a time.
- In order to avoid a sharp drop in pressure inside the abdomen, the surgeon's assistant simultaneously with the paracentesis constantly pulls the patient's stomach with a thin towel.
- When the evacuation of ascites ends, a tight bandage is applied to the puncture and wound, the operation ends, the patient is laid on his right side and allowed to lie down for a while. It is also advisable to tighten the stomach with a large gauze bandage. This will help maintain intrauterine pressure.
Consequences of a puncture in ascites
As practice shows, the diagnostic paracentesis in ascites and pumping out the liquid under it has already proved its high efficiency. But the very procedure of paracentesis( puncture) itself can be accompanied by serious complications. What to beware:
- Non-observance of the rules of antiseptic leads to the development of phlegmon of the abdominal wall - a dangerous disease, in which sepsis often occurs.
- When an incorrect puncture is performed, it is possible to damage large and small vessels, and even abdominal organs.
- Mediastinal emphysema( air accumulation in tissues) is dangerous. Therefore, the removal of fluid in ascites should be performed by an experienced surgeon who has experience with endoscopic equipment.
It should be noted that any puncture in ascites can have dangerous consequences. Before it is held, no one knows with absolute accuracy what the reason for the accumulation of ultrafiltrate. There are less traumatic non-surgical methods of fluid withdrawal in ascites. This is a method of diuretics or traditional medicine. But to be engaged in a selftreatment, in this case it is impossible. Very often it is a constant companion of some oncological diseases, so it becomes such an important puncture of the abdominal cavity with ascites.
When drainage of ultrafiltrate is not provided, a puncture is not done with ascites. In the hospital for diagnosis, a sparing catheter is used. With the help of a conventional syringe, fluid is drawn. If it does not go into the syringe, the abdominal cavity is caked with an isotonic sodium chloride solution, and then the attempt is repeated again. The fence allows you to get the amount of material that is enough to determine all the diagnostic parameters. With the help of a laparocentesis( puncture), you can now perform a visual examination of the abdominal cavity. In this case, a special endoscopic device called a laparoscope must be inserted through the trocar.
Currently, laparocentesis allows to achieve good results. This is the only method of assisting with intense ascites, when the patient has serious respiratory disorders and the threat of a rupture of the umbilical hernia. Multiple application of laparocentesis( puncture) in ascites is possible, when it is necessary to remove a large amount of liquid( more than 10 liters).
As practice shows, one drug treatment does not show the necessary results, in some cases laparocentesis with ascites helps to significantly alleviate the patient's condition, which means, to increase the chances of recovery.