Procedure:

• Persistent leakage following leakage placement can be decreased by using z tract technique.

• Draw up lidocaine into 10 cc syringe using 10 cc syringe and exchange syringe for 27g needle 

• Inject wheel of lidocaine at designated site. Then puncture the center of the wheel and aspirate while advancing to assess for vasculature puncture. Advance until ascites is drawn into the syringe. Then inject lidocaine as you pull the syringe back to numb up the tract.

• Set up catheter and tubing while anesthetic takes effect. 

• Make a stab incision using 11 blade scalpel at center of wheel site. 

• With syringe in place on catheter-over-needle device, pull traction as needle punctures skin and advance needle through stab incision. continue advancing until ascites is returned. then advance 5 cm further to ensure catheter  and needle tip are in peritoneal cavity. 

• Advance catheter forward and do not withdraw needle until catheter has been fully inserted. Once fully advanced withdraw needle and turn stop cock off from patient and connect a 60 cc syringe to get samples for cultures. 

• Drainage tubing can be connected using the Y shaped tubing with 1 way valves. the longner portion of tubing goes to bag. the shorter section of tubing connects to catheter of patient. 1 way valves prevent backflow into abdomen and preferentially push it into the bag for collection. 

• 14 g needle can be connected to vat container. Keep system closed to atmosphere to prevent loss of suction.

• Needs to have hemodynamic monitoring for 1 hour following drainage. If resuscitation is needed the patient will need albumin to help oncotic pressure and decrease risk of hepatorenal syndrome.