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Trick of the Trade: Persistent paracentesis leakage

2016-11-11T18:43:16+00:00

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
Academy Endowed Chair of EM Education
Professor of Clinical Emergency Medicine
University of California, San Francisco
Michelle Lin, MD
Michelle Lin, MD

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  • @DocWagz

    I love the idea. Sometimes hard to apply tissue adhesive over a wet surface. I’ve found a valiant attempt at the Z-technique works really well.

    However, in the thin patient without a lot of belly tissue. This adhesive idea is great.

    • Yes, the Z-technique should always be attempted if possible to pre-empt this problem. Thanks for the tip!

    • Anonymous

      Or try Surgiseal, its a new version of 2-octyl-cyanoacrylate skin adhesives, but waterproof immed V 48hr, better flexibility and strength of 5-O suture.

    • Good point. There are now quite a number of variants on the OCA skin adhesives which supposedly are waterproof immediately. The oxygen by nasal cannula is great for those that don’t quite dry SO quickly. Thanks for commenting.

  • Anonymous

    Thanks for this tip! Just got called in the middle of the night for a paracentesis site that has been leaking copiously for hours. This worked like a charm! Appreciate the tip!

  • Anonymous

    Just tried this (of course in the middle of the night) for a patient of mine who had a para yesterday but is still incredibly tense with ascites. Worked perfectly!

  • rob

    is it dangerous for the body to leak 3 days after

    • blibertad

      For real, bruh?