• Verify the practitioner’s order.
• Confirm that informed consent has been obtained and that the signed consent form is in the patient’s medical record.^{2 , 3 , 4 , 5}
• Review the patient’s history for hypersensitivity to latex or to the local anesthetic.
• Conduct a preprocedural verification to make sure that all relevant documentation, related information, and equipment are available and correctly identified to the patient’s identifiers.^{6 , 7}
• Verify that laboratory and imaging studies have been completed as ordered and that the results are in the patient’s medical record. Notify the practitioner of any unexpected results.⁶
• Gather and prepare the necessary equipment and supplies.
• Perform hand hygiene.^{8 , 9 , 10 , 11 , 12 , 13}
• Confirm the patient’s identity using at least two patient identifiers.¹⁴
• Provide privacy.^{15 , 16 , 17 , 18}
• Reinforce the practitioner’s explanation of the procedure according to the individual communication and learning needs to increase understanding, allay fears, and enhance cooperation. ¹⁹ Reassure the patient that the he or she should feel no pain but may feel a stinging sensation from the local anesthetic injection and pressure from the needle, trocar, or angiocatheter insertion. The patient may also sense pressure when the practitioner aspirates abdominal fluid.
• Instruct the patient to void before the procedure. Alternatively, insert an indwelling urinary catheter, if ordered, to minimize the risk of accidental bladder injury from insertion of the needle, trocar, or angiocatheter. ¹
• Obtain the patient’s weight in kilograms.
• Raise the patient’s bed to waist level before performing patient care to prevent caregiver back strain. ²⁰
• Perform hand hygiene.^{8 , 9 , 10 , 11 , 12 , 13}
• Obtain the patient’s vital signs, oxygen saturation using pulse oximetry, and abdominal girth, and assess respiratory status to serve as a baseline for comparison during and after the procedure. ¹ Use the tape measure to measure the patient’s abdominal girth at the umbilical level. Use a felt-tipped marker to indicate the abdominal area measured.
• Screen and assess for pain using facility-defined criteria that are consistent with the patient’s age, condition, and ability to understand to serve as a baseline for comparison during and after the procedure. ^{1 , 21}
• Treat the patient’s pain, as needed and ordered, using nonpharmacologic, pharmacologic, or a combination of approaches. Base the treatment plan on evidence-based practices and the patient’s clinical condition, past medical history, and pain management goals.²¹
• Make sure the patient has a patent IV catheter in place, if ordered; insert a new IV catheter, if necessary to provide access for administration of IV fluid and sedation, as needed.
• Position the patient in the supine position or on the side to allow the fluid to pool in dependent areas. ¹
• Expose the patient’s abdomen from diaphragm to pubis. Keep the rest of the patient covered to avoid chilling.
• Make the patient as comfortable as possible, and place a fluid-impermeable pad under the patient for protection from drainage.
• Remind the patient to stay as still as possible during the procedure to prevent injury from the needle, trocar, or angiocatheter.
• Perform hand hygiene.^{8 , 9 , 10 , 11 , 12 , 13}
• Open the paracentesis tray using sterile no-touch technique to ensure a sterile field.
• Put on a gown, a mask, goggles, and gloves to comply with standard precautions. ^{22 , 23 , 24}
• Label all medications, medication containers, and other solutions on and off the sterile field.^{25 , 26}
• Assist the practitioner, as needed, with skin preparation and during the procedure.
• Conduct a time-out immediately before starting the procedure to perform a final assessment that the correct patient, site, positioning, and procedure are identified and, as applicable, that all relevant information and necessary equipment are available. ²⁷
• Using the scalpel, the practitioner may make a small incision before inserting the needle, trocar, or angiocatheter (usually 1" to 2" [2.5 to 5 cm] below the umbilicus). Listen for a popping sound, which signifies that the needle, trocar, or angiocatheter has pierced the peritoneum.
• Assist the practitioner with collecting specimens in the proper containers. If the practitioner orders substantial drainage, connect the three-way stopcock and tubing to the needle, trocar, or angiocatheter. Run the other end of the tubing to the drainage bag. Alternatively, aspirate the fluid with a three-way stopcock and 50-mL syringe.
• Label the specimen tubes in the presence of the patient to prevent mislabeling, and send them to the laboratory in a laboratory biohazard transport bag (with appropriate laboratory request forms if required by your facility).^{14 , 24} If the patient is receiving antibiotics, note this information on the request form for consideration during the fluid analysis.
• Gently turn the patient from side to side to enhance drainage, if necessary.¹
• As the fluid drains, monitor the patient’s vital signs and oxygen saturation level frequently. Observe the patient closely for vertigo, faintness, diaphoresis, pallor, heightened anxiety, tachycardia, dyspnea, and hypotension, especially if more than 5 L of peritoneal fluid was aspirated at one time. In rare cases, this loss may induce a fluid shift and hypovolemic shock. ²⁸ Immediately report signs of shock to the practitioner.
• Administer IV albumin, as ordered, to prevent hypovolemia and a decline in kidney function. ^{21 , 28 , 29 , 30 , 31 , 32}
• When the procedure ends and the practitioner removes the needle, trocar, or angiocatheter, apply pressure to the wound using sterile 4" × 4" (10-cm × 10-cm) gauze pads. If the wound still leaks after 5 minutes, the practitioner may suture the incision.¹ Alternatively, if permitted in your facility, remove the paracentesis catheter, as directed (some facilities permit a specially trained nurse to remove the catheter).
• Remove and discard your gloves,^{22 , 24}, perform hand hygiene,^{8 , 9 , 10 , 11 , 12 , 13} and put on gloves.^{22 , 24}
• When drainage becomes minimal, remove and discard the pressure dressing; apply dry sterile gauze pads and tape them to the site.

NURSING ALERT If the patient has fragile skin, use dressings and tape specifically formulated for fragile skin to prevent skin stripping during removal. ³³

• Help the patient assume a comfortable position.
• Monitor the patient’s vital signs, oxygen saturation level, and respiratory status at an interval determined by your facility because no evidence-based research indicates best practice for the frequency of vital sign assessment after a procedure. ³⁴ Make sure that alarm limits are set properly for the patient’s current condition and that alarms are turned on, functioning properly, and audible to staff.^{35 , 36 , 37 , 38}
• Check the dressing for drainage. Be sure to note drainage color, amount, and characteristics.
• Reassess and respond to pain by evaluating the patient’s response to treatment and progress toward pain management goals. Assess for adverse reactions and risk factors for adverse events that may result from treatment.²¹
• Monitor the patient’s intake and output at an interval determined by the patient’s condition and your facility.¹
• Return the bed to the lowest position to prevent falls and maintain patient safety. ³⁹
• Discard used supplies in the appropriate receptacles.²⁴
• Remove and discard your gloves and other personal protective equipment.^{22 , 24}
• Perform hand hygiene.^{8 , 9 , 10 , 11 , 12 , 13}
• Clean and disinfect your stethoscope using a disinfectant pad.^{40 , 41}
• Perform hand hygiene.^{8 , 9 , 10 , 11 , 12 , 13}
• Document the procedure.^{42 , 43 , 44 , 45}