Abdominal puncture point

Abdominal puncture is a diagnostic and treatment technique in which a puncture needle is inserted directly into the peritoneal cavity from the anterior abdominal wall. Abdominal puncture is widely used in clinical work, especially in the diagnosis of acute abdomen. Timely abdominal puncture can not only obtain a clear diagnosis, but also buy valuable time for treatment. This method is simple, quick, requires no special equipment, and causes little pain to the patient. Abdominal puncture catheterization provides another way to administer medication for cancer patients (especially those in the advanced stage). So let’s learn about abdominal puncture below!

Abdominocentesis is a diagnostic and treatment technique that uses a puncture needle to directly pierce the peritoneal cavity from the anterior abdominal wall. The exact name should be peritoneal cavity puncture. The purpose is to clarify the nature of the ascites and drain the ascites.

I. Definition

Diagnostic and therapeutic techniques using a puncture needle to penetrate the peritoneal cavity

2. Full name

Peritoneocentesis

3. Purpose

Determine the nature of the abdominal effusion; drain the ascites, etc.

4. Chinese name

Abdominal puncture

5. Purpose of surgery

① Clarify the nature of the peritoneal effusion, identify the pathogen, and assist in diagnosis.

② Drain an appropriate amount of ascites to reduce the patient's intra-abdominal pressure, relieve symptoms such as abdominal distension, chest tightness, shortness of breath, and difficulty breathing, reduce venous return resistance, and improve blood circulation.

③Inject drugs into the peritoneal cavity.

④ Inject a large amount of air (artificial pneumoperitoneum) to increase abdominal pressure, raise the diaphragm, indirectly compress the two lungs, reduce lung mobility, and promote the healing of lung cavities. When there is severe bleeding in tuberculosis cavities, artificial pneumoperitoneum can be used as a hemostatic measure.

⑤Perform ascites concentration and re-infusion.

⑥ Diagnostic (such as abdominal trauma) or therapeutic (such as severe acute pancreatitis) peritoneal lavage.

6. Indications

1. The cause of ascites is unknown, or internal bleeding is suspected.

2. Patients with unbearable breathing difficulties and abdominal distension caused by large amounts of ascites.

3. Those who need intraperitoneal injection of drugs or ascites concentration and then injection.

7. Contraindications

1. Patients with extensive peritoneal adhesions.

2. Patients with precursors of hepatic encephalopathy, hydatid disease and giant ovarian cysts.

3. Large-scale ascites drainage is contraindicated in patients with large amounts of ascites and severe electrolyte imbalance.

4. Those who are mentally abnormal or unable to cooperate.

5. Pregnancy.

8. Surgical Method

1. Preoperative guidance

1. Empty your bladder before puncture to avoid damaging the bladder during puncture. Abdominal puncture generally has no special adverse reactions.

2. During puncture, adopt an appropriate position according to the patient's condition, such as sitting, semi-sitting, supine, and lateral positions, and select a suitable puncture point based on the position.

3. Explain to the patient that releasing too much fluid at one time may cause water and salt metabolism disorders and induce hepatic coma, so be cautious. After a large amount of fluid is released, a multi-head abdominal belt should be worn to prevent a sudden drop in abdominal pressure and visceral vascular dilation, which may cause shock. Before and after the drainage, measure your body weight and abdominal circumference as directed by your doctor in order to observe changes in the condition.

4. If you feel dizzy, nauseous, palpitations, or difficulty breathing during the operation, you should inform the medical staff in time for timely treatment.

2. Preoperative preparation

1. Disinfection of operating room

2. Check the patient's name, medical records, abdominal plain film and related auxiliary examination materials

3. Clean your hands (spray disinfectant on your hands or wash your hands)

4. Do a good job in the patient's ideological work, explain to the patient the purpose and general process of puncture, eliminate the patient's concerns, and strive for full cooperation.

5. Measure blood pressure , pulse, waist circumference, and check abdominal signs

6. Ask the patient to urinate before surgery to prevent bladder injury

7. Prepare the abdominal puncture kit, sterile gloves, masks, caps, 2% lidocaine, 5ml syringe, 20ml syringe, 50ml syringe, disinfectants, adhesive tape, containers, measuring cups, curved plates, 500ml normal saline, medicines required for intraperitoneal injection, several sterile test tubes (for routine, biochemical, bacterial, and pathological specimens), multi-head abdominal belt, chair with reclining back, etc.

8. Wear a hat and mask.

9. Guide the patient into the operating room.

(III) Operation steps

1. Part selection

(1) 1 cm above the midpoint of the line between the umbilicus and the upper edge of the pubic symphysis, and 1 to 2 cm to the left or right. There are no important organs at this location, so puncture is relatively safe. There are no important organs here and it is easy to heal.

(2) The puncture point in the left lower abdomen is at the junction of the middle 1/3 and outer 1/3 of the line connecting the umbilicus and the left anterior superior iliac spine. This point can avoid damaging the inferior epigastric artery, and the intestinal tract is relatively free and less prone to damage. When draining ascites, the left puncture point is usually used, as it is less likely to damage the abdominal wall artery.

(3) The puncture point in the side-lying position is the intersection of the umbilical plane and the anterior axillary line or the mid-axillary line. Puncture here is mostly suitable for diagnostic puncture of small amounts of fluid in the peritoneal cavity.

2. Body position reference

Depending on the condition and needs, the patient can be placed in a sitting, semi-recumbent or supine position, and try to make the patient comfortable so that he or she can tolerate a longer operation time. For patients suspected of intra-abdominal bleeding or with a small amount of ascites, experimental puncture should be performed in the lateral decubitus position.

3. Piercing level

(1) The puncture point is located at the midline of the lower abdomen through the skin, superficial fascia, linea alba or inner edge of the rectus abdominis muscle (if the puncture point is 2 cm away, the anterior layer of the rectus sheath and the rectus abdominis muscle may also be involved), transverse abdominal fascia, extraperitoneal fat, and parietal peritoneum, and enters the peritoneal cavity.

(2) The puncture point in the left lower abdomen is through the skin, superficial fascia, external oblique muscle, internal oblique muscle, transverse abdominal muscle, transverse abdominal fascia, extraperitoneal fat, and parietal peritoneum to enter the peritoneal cavity.

(3) The puncture point in the lateral position is at the same level as the puncture point in the left lower abdomen.

4. Puncture

A. Disinfection and drape laying

a. Apply iodine to the puncture site. Disinfect the skin from the inside out, with a disinfection range of about 15 cm in diameter. After the iodine tincture has dried, repeat the disinfection once more.

b Untie the bandage of the paracentesis bag, put on sterile gloves, open the paracentesis bag (assistant), spread a sterile drape, and cover the hole in the drape with a sterile dressing.

c Before the operation, check whether the items in the abdominal puncture kit are complete: No. 8 or 9 abdominal puncture needle with latex tube, small forceps, hemostatic forceps, infusion clamps, gauze, and drape.

B. Local anesthesia

aThe operator checks the name and concentration of the anesthetic, the assistant tears open the package of the disposable syringe, the operator takes out the sterile syringe, the assistant breaks open the anesthetic ampoule, the operator draws 2 ml of anesthetic with a 5 ml syringe, and uses 2% lidocaine for local anesthesia from the skin to the peritoneal wall. There should be a skin papule on the anesthetized skin. Aspiration should be done before injection. The anesthetic can be injected only after observation that there is no blood or ascites.

C The puncturist fixes the skin at the puncture site with his left hand, holds the needle with his right hand and vertically inserts it into the abdominal wall through the anesthesia site. When the resistance of the needle tip suddenly disappears, it indicates that the needle tip has passed through the peritoneal wall. After the assistant puts on gloves, he uses a sterilized vascular clamp to help fix the needle. The operator draws ascites and keeps a sample for examination. Diagnostic puncture can be performed directly using a 20ml or 50ml syringe and an appropriate needle. When draining a large amount of fluid, you can use a No. 8 or No. 9 needle and connect a rubber tube to the needle holder. Use the infusion clamp to adjust the speed and introduce the ascites into the container to record the amount and send it for testing.