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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.

 

Michelle Lin, MD
ALiEM Editor-in-Chief
Editorial Board Member, Annals of Emergency Medicine
UCSF Academy Endowed Chair for EM Education
UCSF Associate Professor of Emergency Medicine
San Francisco General Hospital
Michelle Lin, MD