Department of Medicine, Queen's University, Kingston, ON, Canada.
J Gen Intern Med. 2022 May;37(7):1598-1602. doi: 10.1007/s11606-021-07042-7. Epub 2021 Aug 3.
Paracentesis is a bedside procedure to obtain ascitic fluid from the peritoneum. Point-of-care ultrasound (POCUS) improves the safety of some medical procedures. However, the evidence supporting its utility in paracentesis is limited.
We aimed to assess if POCUS would yield a user-preferred site for needle insertion compared to conventional landmarking, defined as a ≥ 5 cm change in location.
This was a prospective non-randomized trial comparing a POCUS-guided site to the conventional anatomic site in the same patient.
Adult patients at Kingston Health Sciences Centre undergoing paracentesis were included.
Physicians landmarked using conventional technique and compared this to a POCUS-guided site. The paracentesis was performed at whatever site was deemed optimal, if safe to do so.
Data collected included the distance from the two sites, depth of fluid pockets, and anatomic considerations.
Forty-five procedures were performed among 30 patients and by 24 physicians, who were primarily in their PGY 1 and 2 years of training (33% and 31% respectively). Patients' ascites was mostly due to cirrhosis (84%) predominantly due to alcohol (47%) and NAFLD (34%). Users preferred the POCUS-guided site which resulted in a change in needle insertion ≥ 5 cm from the conventional anatomic site in 69% of cases. The average depth of fluid was greater at the POCUS site vs. the anatomic site (5.4±2.8 cm vs. 3.0±2.5 cm, p < 0.005). POCUS deflected the needle insertion site superiorly and laterally to the anatomic site. The POCUS site was chosen (1) to avoid adjacent organs, (2) to optimize the fluid pocket, and (3) due to abdominal wall considerations, such as pannus. Six cases landmarked anatomically were aborted when POCUS revealed inadequate ascites.
POCUS changes the needle insertion site from the conventional anatomic site for most procedures, due to optimizing the fluid pocket and safety concerns, and helped avoid cases where an unsafe volume of ascites was present.
腹腔穿刺术是在床边从腹膜中抽取腹水的一种操作。即时超声（POCUS）提高了一些医疗操作的安全性。然而，支持其在腹腔穿刺术中应用的证据有限。
我们旨在评估 POCUS 是否会产生比传统体表标志法更优的进针部位，以进针部位变化≥5cm 为标准。
这是一项前瞻性非随机试验，比较了 POCUS 引导下的部位与同一患者的传统解剖部位。
金斯顿健康科学中心接受腹腔穿刺术的成年患者。
医生使用传统技术进行体表标志，并将其与 POCUS 引导下的部位进行比较。如果安全可行，则在认为是最佳的部位进行穿刺。
收集的数据包括两个部位之间的距离、液袋的深度和解剖学考虑因素。
30 名患者中有 45 例由 24 名医生进行了操作，这些医生主要处于 PGY1 和 2 年的培训阶段（分别占 33%和 31%）。患者的腹水主要是由肝硬化（84%）引起的，主要是由酒精（47%）和非酒精性脂肪性肝病（34%）引起的。使用者更喜欢 POCUS 引导的部位，在 69%的情况下，与传统解剖部位相比，进针部位的变化≥5cm。POCUS 引导的部位的液体深度大于解剖部位（5.4±2.8cm 比 3.0±2.5cm，p<0.005）。POCUS 使针的插入部位向解剖部位的上方和外侧偏移。选择 POCUS 部位是为了（1）避免邻近器官，（2）优化液袋，（3）考虑腹壁因素，如赘肉。6 例在解剖学上进行体表标志的病例因 POCUS 显示腹水不足而被中止。
由于优化了液袋和安全性问题，POCUS 改变了大多数操作的传统体表标志进针部位，并有助于避免出现不安全量腹水的情况。
