Name:
24-03-0175_TTV
Description:
24-03-0175_TTV
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/bcba1bff-defa-48bc-b7b2-37efebb81d98/videoscrubberimages/Scrubber_1.jpg?sv=2019-02-02&sr=c&sig=Q0%2BV7YEubE4SZT07KcjPDeD8zJG6gqESfcIkq346IHk%3D&st=2024-12-26T11%3A16%3A28Z&se=2024-12-26T15%3A21%3A28Z&sp=r
Duration:
T00H05M02S
Embed URL:
https://stream.cadmore.media/v10.2460/javma.24.03.0175
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/bcba1bff-defa-48bc-b7b2-37efebb81d98/24-03-0175_TTV.mp4?sv=2019-02-02&sr=c&sig=71JMvnL8omZ76Mdo3%2Fb2n3zWjYJ%2BOdl7VjeFfhMeh0c%3D&st=2024-12-26T11%3A16%3A28Z&se=2024-12-26T13%3A21%3A28Z&sp=r
Upload Date:
2024-12-26T11:21:28.2051407Z
Transcript:
Language: EN.
Segment:0 .
Hello, my name is George Munguia and we will be presenting a video tutorial on common abdominal diagnostic procedures. The authors do not have any conflicts of interest to disclose. Indications for abdominocentesis include a fluid wave on abdominal palpation, radiographic evidence of poor serosal detail or ultrasonic evidence of free peritoneal fluid.
Remember, very young or thin patients may have poor serosal margination on radiographs that is not related to free fluid. When abdominocentesis yields fluid, collect it in the following order. First, place one drop of fluid on a slide for your own in-house cytology. Second, a purple top EDTA tube for cell counts and cytology submitted to a pathology lab.
Third, a red top or serum tube for biochemical testing. The value obtained from the abdominal fluid is compared to the serum values. The red top tube can also be used to collect a sterile culture sample. In most cases of septic peritonitis, do not delay an exploratory laparotomy while waiting for culture results. Abdominocentesis can be conducted blindly, as in the four quadrant tap, or via ultrasound guidance.
Place the patient in lateral recumbency to minimize contact with the spleen and clip an approximately 10 centimeter by 10 centimeter area surrounding the umbilicus. The procedure can also be done in right lateral recumbency or standing. Aseptically prepare the skin. To create the four quadrants, imagine two lines, one along the ventral midline and the second perpendicular at the point of the umbilicus.
Firmly but gently insert an 18- or 20-gauge, 1 inch needle to its hub, 1 to 2 centimeters from the umbilicus within a quadrant. If there is no effusion, continue adding a needle to each quadrant until effusion is produced from one or more needle hubs. Gently twisting the needles can promote flow. If no fluid appears after waiting at least one minute attach a 3-mL syringe to one of the dependent needles and gently aspirate.
Collect any fluid in the order discussed previously. Several reasons exist for a negative 4 quadrant tap. The patient can have less than 10 mL per kg of abdominal effusion; there could be fluid that is sequestered in places such as between the liver and diaphragm or in small pockets between intestinal loops; the needle could be blocked with omentum; or the fluid is too thick or viscous to draw out.
To minimize this complication, do not use smaller than a 20-gauge needle. Ultrasound guidance allows for fluid collection with smaller volumes of effusion, less than 5 mL per kg, and may allow for collection of entrapped fluid. To perform ultrasound guided abdominocentesis place the animal in lateral or dorsal recumbency or allow it to stand. After locating fluid in a good window, for example, without the need to pass through another structure, clip and clean the site.
Keep the ultrasound probe marker pointed toward the head of the patient at a 60 degree angle to the skin. Using an 18- to 22-gauge needle with a 3- to 6-mL syringe attached, insert the needle, bevel toward the probe, about 1 centimeter from the probe. Visualize the needle penetrating into the fluid prior to pulling back on the syringe. Advantages of ultrasound guidance include direct visualization of fluid with less risk of collateral organ damage.
Disadvantages include the need for training and practice and the fact that very small or very sequestered pockets of fluid without a good window and fluid located near structures prone to bleed still cannot be sampled. Intra-abdominal pressure measurement is useful when an animal has decreased abdominal wall compliance, increased intraluminal contents, accumulation of intraperitoneal fluid, air, or blood, ascites from a capillary leak.
The easiest method to measure IAP is via using intravesicular bladder pressure to approximate intra-abdominal pressure. The patient is placed in lateral recumbency and a Foley urinary catheter is placed aseptically and attached to 2 3-way stopcocks. One stopcock is attached to a bag of saline and the second to a water manometer or extension set and ruler. The second stopcock is also attached to a syringe or collection bag.
The bladder is emptied into the collection bag and 0.5 to 1 mL per kg of saline from the bag is used to distend the bladder slightly. Zero the system to the patient's midline at the pubic symphysis. Fill the manometer with saline. Close the stopcock to the fluid source and allow the column of water in the manometer to equilibrate to the pressure in the bladder and therefore the abdomen.
Repeat at least 3 times and average the readings. Abdominal pressure readings above 12 centimeters of water can impact perfusion to the tissues and indicate need for treatment. In conclusion, abdominocentesis is a common procedure performed in small animal practice with and without ultrasound guidance. Measuring intra-abdominal pressure serially can guide treatment.
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