<aside> ⚠️

Don’t perform a para if:

• Uncontrolled bleeding disorder
• No safe pocket
• You have to go through an infection or surgical scars </aside>

Supplies (click toggle)

Before you get sterile

1. Empty the bladder (pee or catheterize), although this is less important with ultrasound guidance as you should ideally be able to identify the bladder.
2. Make sure the patient is on a cardiac monitor, to evaluate heart rate and O2 saturation during the procedure.
3. Elevate the head of the bed, to promote fluid collection in the abdomen.
4. Roll the patient toward you, to allow fluid to collect on that side (bowel will float)
5. Use ultrasound to identify a safe pocket. This should be in the LLQ or RLQ. Be lateral of the abs to avoid the inferior epigastric artery.

<aside> ⚠️

A safe pocket should have the following:

Pocket is >2 cm deep

There are no overlying blood vessels. If you want to be extra careful, use the high-frequency “linear probe” to see vessels better.

</aside>

1. Mark your insertion site, ideally using a skin pen. Using suction on a syringe to leave a skin indentation works too.
2. Prep a wide area of skin using chlorhexidine. However wide you made it, make it wider, so that you have a lot of space to work with.

Sterile

1. Put on a mask, a cap, and sterile gloves.
2. Make a sterile field using drapes.
3. Use a 25-gauge needle to place a wheal of 1% lidocaine anesthetic over your insertion site. You can use lidocaine with or without epinephrine.
4. Use a 22-gauge needle to inject anesthetic deeper into the subcutaneous tissue. Aspirate with negative pressure before injecting to avoid blood vessels. You can insert your needle until you aspirate peritoneal fluid. Remove the needle when done.