Equipment for Ascitic Tap and Drain:

• Sterile trolley, sterile gloves and sterile field
• Chlorhexidine (ChloraPrep)
• One orange and two green needles
• Local anaesthetic (1% Lidocaine)
• 10ml syringe for lidocaine
• 20ml syringe (50ml syringe recommended if sending for cytology)
• Collection container (sterile specimen pot for fluid or bag for drainage)
• 21 gauge needle for ascitic tap or local ascitic drain pack
• Scalpel blade (optional for drainage)
• Ultra-sound machine (if guidance is required)

Preparation:

• Explain the procedure and obtain informed consent, detailing risks (infection, bleeding, pain, organ damage, leakage, and failure).
• Ensure the patient empties their bladder to avoid confusion between urine and ascitic fluid.

Positioning and Site Identification:

• Position the patient supine, angled slightly towards you, with the abdomen exposed.
• Locate the area of maximum fluid (use ultrasound or percuss the fluid level).
• Mark the insertion site, in the right or left lower quadrant, ~2 fingers breadth above and medial to the ASIS.

Procedure:

Sterile Preparation:

• Prepare a sterile field, clean the skin with chlorhexidine, and let it dry.
• Don sterile gloves and apply a drape over the marked site.

Local Anesthetic and Z-Tracking Technique:

• Stretch the skin downward (to create a Z-track).
• Use a 5ml syringe with 1% lidocaine:
  • Orange needle for superficial injection.
  • Green needle for deeper layers into the peritoneum.
• Advance the needle in 5mm increments, aspirating to confirm ascitic fluid.

Performing the procedure

• For an ascitic tap: Insert a 21G needle attached to a 20/50ml syringe using Z-tracking and aspirate required fluid.
• For an ascitic drain: Follow local drain kit instructions. Confirm fluid return and connect to a drainage bag. Remove up to 6L of fluid or stop after 6 hours.

Post-Procedure:

• Remove the needle/catheter, apply a sterile dressing, and lie the patient on their side with the puncture site upwards to minimise leakage.
• Send fluid samples for MC&S, biochemistry, and cytology.

Drainage and monitoring:

• Remove the catheter after draining the desired volume.
• Apply a sterile dressing and ensure no fluid leakage.
• Document the procedure (amount of fluid drained, appearance, patient’s response).
• Monitor the patient post-procedure for complications like bleeding or infection.
• An ascitic drain is generally a very safe procedure but requires close supervision. A common complication during drainage is hypotension due to fluid shifts. To mitigate this, 100 mL of 20% human albumin is sometimes administered for every 2L of ascitic fluid drained.

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