1. Prepare the patient for a standard paracentesis, and place the patient on a monitor.
2. Ensure that wall suction is available, and attach standard tubing to the wall, with the opposite end connected to the first suction canister.
3. Another piece of tubing is then used to attach the first canister to a second canister.
4. It is important to note that most canisters have one port with a self-sealing filter (see
Figure 2). Using this port will close the system and prevent continuous flow, so it is necessary to avoid this port, except for first canister connected to the wall.
5. Once all of the tubing is connected, ensure that all other ports are capped and sealed.
6. This process for adding canisters can be repeated several times, depending on the amount of fluid to be drained. This will effectively create a suction “train,” as shown in Figure 3.
7. After you have the desired number of canisters in your “train,” take the final end of suction tubing and place it tightly into a syringe (you must first remove the plunger). Based on the size of suction tubing used and syringes at your hospital, this setup may vary, as shown in Figure 4.
8. After successful insertion of the catheter into the peritoneal cavity, the suction syringe can be attached directly to the paracentesis catheter or first to a 3-way stopcock, as explained below in Step 10 (see Figure 5).
9. Turn the paracentesis catheter valve to the open position, and turn on the wall suction. The fluid will begin to drain into the first canister of the “train.” After filling the first canister to capacity, the fluid will continue to drain into the adjacent canister(s) without any intervention.
10. If you find that the flow stops, presumably from siphoning a loop of bowel to the catheter tip, you can integrate a 3-way stopcock with a syringe into the system (Figure 6A). This will allow you to flush the catheter with sterile saline or, preferably, the patient’s own ascitic fluid in order to push any bowel wall away from the catheter tip. If the flow stops, turn the 3-way stopcock to the off position to the suction syringe. Place the valve to the open position to a 10 ml or 50 ml syringe filled with the patient’s ascitic fluid; then flush 5–10 ml at a time through the catheter in an attempt to restore flow to the suction tip (Figure 6B). Ultrasound may also be used to determine the location of the catheter tip while flushing the fluid. Return the valve to the open position to the suction syringe, and resume the removal of ascitic fluid once flow is restored.