Did you adequately numb the peritoneum for your paracentesis?
If it looks like this then yes! Yes, you did. Congratulations. Your patient thanks you (and may ask for you by name next time!)
#ultrasound #irad #MedTwitter #MedEd #POCUS
If it looks like this then yes! Yes, you did. Congratulations. Your patient thanks you (and may ask for you by name next time!)
#ultrasound #irad #MedTwitter #MedEd #POCUS
For any intra abdominal needle passage, pain crossing the skin and peritoneum (sometimes muscles too) are worst. The 25G lido needle isn't too bad, but if you try to pass a 5 French without good local anesthesia, they're going to feel it.
Paracentesis is a great procedure for learning US/needle skills. Make sure you 👀your needle tip OVERLYING the deepest, echogenic, anterior abdominal wall layer and numb, numb, numb. If that layer pushes away from you, chase it with your needle!
If you don't see the peritoneal-peel (maybe scarred from lots of paras?), make sure to pass your needle tip into the fluid (totally fine!) and numb back and forth across the peritoneum.
Then, boom. Right in with the catheter.
(May seem obvious, but make sure to cross where you numbed.)
(May seem obvious, but make sure to cross where you numbed.)
This is a "simple" procedure a lot of people don't take the time to learn how to do well. But, especially with chronic para patients, they know (and feel) the difference.
Remember:
Painless para = Happy patient
Remember:
Painless para = Happy patient
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