Tuesday, July 11, 2006

Tuesday July 11, 2006
Paracentesis with seldinger technique / with central venous catheter kit

During paracentesis regular single, double or triple lumen central venous catheter may provide some benefits over angiocath (catheter over needle). Using regular central venous catheter kit's needle, advance till you get ascitic fluid. Now pass J-wire through needle upto appropriate length ------->remove the needle ----> advance your catheter over wire -----> remove the wire ----> if you don't see fluid, slowly pull back the catheter till you get flow. Advantages of this technique:

1) This is relatively safe as paracentesis needle in available kits are usually long and may carry risk of trauma if you keep advancing at non-ascitic area. (In commercial kits, usual length of catheter and needle is about 19 cm/ 7.5 inches).

2) While advancing catheter away from needle, it may get kinked. Catheter getting advanced over wire is unlikely to get kinked.

3) Use catheter from original kit as it may provide advantage of bigger diameter but in large fluid removal you may use tripple lumen catheter and leave it lock like regular central line for 4/5 days to drain required fluid everyday.

4) Multiple ports may allow you to drain in 2/3 bags/bottles simultaneously.

Editors' note: Contributor of this peal is a practicing intensivist but request to hold his and institution's name. We often post bedside tips which are fully anecdotal and individual's idea and may not be evidence based. Use it per your discretion.