Trick of the Trade: Persistent paracentesis leakage

Nov 06, 12
Trick of the Trade: Persistent paracentesis leakage

Paracentesis-1Dr. Matt Borloz (Carilion Clinic) recently emailed me his recent trick in fixing a persistently leaking paracentesis site. Read about his experience:

A patient with advanced alcoholic cirrhosis with ascitic fluid leaking from a paracentesis puncture site from a procedure done 2 days prior. Dermabond had initially been applied post-procedure, but it had come loose, and ascitic fluid had been saturating dressing after dressing. 

I initially tried a figure-eight stitch with no luck. In fact, this just made a couple more leaking holes. I had made the problem worse. I followed this with another trial of Dermabond. Now the problem was that the field just kept getting wet, and the Dermabond would not dry.  

Trick of the Trade: Fix paracentesis leakage with tissue adhesive

  1. Use a tissue adhesive to occlude the puncture site.
  2. Apply high-flow oxygen via nasal cannula to dry the glue.

Ascites leak solution

Dr. Borloz: I hooked a nasal cannula up to oxygen and turned it all the way up to act as a concentrated stream of directed air. This both dried the ascitic fluid and hastened the solidification of the Dermabond.  I applied multiple layers. It worked great.  No more leak.

 

Author information

Michelle Lin, MD

ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco

The post Trick of the Trade: Persistent paracentesis leakage appeared first on ALiEM.

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