Paracentesis leakage

You’re seeing a patient returning to the ED after a recent diagnostic paracentesis. The patient is complaining of persistent peritoneal fluid leakage. They’ve tried putting pressure with no success. You tried applying a medical adhesive glue and noticed it was unsuccessful, based on the patient’s gown continuing to get wet with ascites fluid. Now what?

Trick of the Trade: Pressure Gauze and Transparent Film Dressing  

The medical adhesive glue trick was proposed in the Trick of the Trade 1.0 version by Dr. Borloz and Dr. Lin in November 2012. 

Materials Needed

MaterialQuantity
Benzoin tincture1
Gauze 2″ x 2″1-2
Transparent Film Dressing (Tegaderm) 2.5″ x 2.75″3-4

Technique

1. Apply benzoin tincture surrounding the area of the leakage.
gauze ball in hand
2. Use a 2″ x 2″ gauze and roll it into a tight round ball. Hold the gauze with firm pressure over the leak (it is easier if you have the patient or an assistant holding it in place while you move on to the next step).
4. Stretch the transparent film dressing before placing it over the center of the gauze
4. Continue to hold firm pressure on the gauze from over thetransparent film dressing. Note that you are not yet touching the dressing against the skin.
5. Stretch outtransparent film dressing and affix to the patient’s skin.
6. Once you apply the initial transparent film dressing, you can apply 2-3 more over the top, in the same fashion, to increase the pressure on and security of the dressing. Patients may be discharged with this dressing in place for 24-48 hours.

Pro Tip

Consider combining both this trick of the trade and the adhesive glue technique. Hat tip to Dr. Christian Rose [Twitter @RoseLikeTheFlwr] for this idea. 

Interested in other Tricks of the Trade posts?

Read the series of Tricks of the Trade posts.

Carmen Estrada

Carmen Estrada

Medical student
UC Davis School of Medicine
Carmen Estrada

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Al'ai Alvarez, MD

Al'ai Alvarez, MD

Clinical Assistant Professor
Director of Well-being
Co-Chair, The Human Potential Team
Department of Emergency Medicine
Stanford University School of Medicine
Al'ai Alvarez, MD

@alvarezzzy

Well-Being Director|Co-Chair, Human Potential Team|#EMWellness @StanfordEMED#selfcompassion#doctorsarehumanstoo#DEI🏳️‍🌈•#HPRT|ex-🌲APD|@SUBiodesign fellow