Avoiding Death and Janitorial Complaints: Remember to keep the Foley bag LOWER than the patient to avoid sucking air into the patient’s peritoneum, especially at the end of the procedure. When discarding ascites from Foley bag, let it drain out into your disposal system cautiously without a lot of splashing, and wear eye and mouth protection. Since the patient is usually still numb from the initial local anesthesia, I put a figure-of-8 stitch around the perforation site to keep any residual fluid from oozing out (a common patient complaint). I prefer an absorbable suture to spare the patient a return trip. Cover the site with an occlusive dressing.

There are tales of patients going into shock or having spontaneous peritoneal bleeds after large volume paracentesis, and while these complications are reportedly rare it is a good idea to observe the patient in the department for an hour after the procedure has been completed. Sandwiches and promises of cab fare are your greatest weapons here, should you choose to use them.

Have a nifty idea you’d like to see on Tricks of the Trade? E-mail it to me at fisherwhit@gmailwww.acepnews.com, and I promise to give you credit if I use it.

Dr. Fisher practices Emergency Medicine in New England and New York.