Emergent Neonatal Abdominal Paracentesis: A Step-by-Step Video Simulation

Evacuation of ascites with resultant cardiorespiratory compromise.

Signs of ascites with resultant cardiorespiratory compromise.

• i. Signs:

  • 1. Tense abdominal distention.

  • 2. Hypoxia or bradycardia despite adequate ventilatory efforts and no other clear etiology, particularly in the setting of prenatally diagnosed or postnatally apparent abdominal ascites or hydrops fetalis.

• ii. The aforementioned signs may not always be present.

There are no absolute contraindications to this procedure in an emergent setting.

This is an invasive procedure and should not be performed if the decision has been made for redirection unless approved by the family.

Relative contraindications:

• i. Massive hepatosplenomegaly:

  • 1. If isolated hepatomegaly is present, consider using the left lower quadrant for needle insertion.

  • 2. If isolated splenomegaly is present, consider using the right lower quadrant for needle insertion.

• ii. Large abdominal wall defects overlying site of needle insertion.

• iii. Bleeding disorder including severe thrombocytopenia or coagulopathy.

All relative contraindications, risks, and benefits need to be assessed in the context of an emergent situation.

• i. If the procedure is being performed in a high-risk situation, strongly consider ultrasound guidance if it is available in your institution.

This video provides instruction on how to perform an abdominal paracentesis in an emergency (Video). …