Logo

Log In Sign Up |  An official publication of: American College of Emergency Physicians
Navigation
  • Home
  • Multimedia
    • Podcasts
    • Videos
  • Clinical
    • Airway Managment
    • Case Reports
    • Critical Care
    • Guidelines
    • Imaging & Ultrasound
    • Pain & Palliative Care
    • Pediatrics
    • Resuscitation
    • Trauma & Injury
  • Resource Centers
    • mTBI Resource Center
  • Career
    • Practice Management
      • Benchmarking
      • Reimbursement & Coding
      • Care Team
      • Legal
      • Operations
      • Quality & Safety
    • Awards
    • Certification
    • Compensation
    • Early Career
    • Education
    • Leadership
    • Profiles
    • Retirement
    • Work-Life Balance
  • Columns
    • ACEP4U
    • Airway
    • Benchmarking
    • Brief19
    • By the Numbers
    • Coding Wizard
    • EM Cases
    • End of the Rainbow
    • Equity Equation
    • FACEPs in the Crowd
    • Forensic Facts
    • From the College
    • Images in EM
    • Kids Korner
    • Medicolegal Mind
    • Opinion
      • Break Room
      • New Spin
      • Pro-Con
    • Pearls From EM Literature
    • Policy Rx
    • Practice Changers
    • Problem Solvers
    • Residency Spotlight
    • Resident Voice
    • Skeptics’ Guide to Emergency Medicine
    • Sound Advice
    • Special OPs
    • Toxicology Q&A
    • WorldTravelERs
  • Resources
    • ACEP.org
    • ACEP Knowledge Quiz
    • Issue Archives
    • CME Now
    • Annual Scientific Assembly
      • ACEP14
      • ACEP15
      • ACEP16
      • ACEP17
      • ACEP18
      • ACEP19
    • Annals of Emergency Medicine
    • JACEP Open
    • Emergency Medicine Foundation
  • About
    • Our Mission
    • Medical Editor in Chief
    • Editorial Advisory Board
    • Awards
    • Authors
    • Article Submission
    • Contact Us
    • Advertise
    • Subscribe
    • Privacy Policy
    • Copyright Information

How To Use Continuous Wall Suction for Paracentesis

By Jordan Jeong, DO, Justin McNamee, DO, and Mark Rosenberg, DO, MBA, FACEP, FACOEP-D | on July 9, 2014 | 3 Comments
Tricks of the Trade
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
Print-Friendly Version
Figure 1.

You Might Also Like
  • Ultrasound-Guided Paracentesis
  • Detect Cardiac Regional Wall Motion Abnormalities by Point-of-Care Echocardiography
  • American Board of Anesthesiology Moves to Continuous Maintenance of Certification
Explore This Issue
ACEP Now: Vol 33 – No 07 – July 2014

Figure 1.

  • 3-way stopcock
  • Tubing elbow
  • 3, 5, or 10 ml syringe
  • Suction tubing
  • Paracentesis tray
  • Several suction canisters
  • Technique

    Figure 2.

    Figure 2.

    Figure 3.

    Figure 3.

    Figure 4.

    Figure 4.

    Figure 5.

    Figure 5.

    Figure 6.

    Figure 6.

    Figure 6a.

    Figure 6a.

    Figure 7.

    Figure 7.

    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.

    Pages: 1 2 3 | Single Page

    Topics: Abdominal and GastrointestinalEmergency DepartmentEmergency MedicineEmergency PhysicianParacentesisProcedures and Skills

    Related

    • 10 Essentials for Your Emergency Department Fanny Pack

      June 17, 2025 - 0 Comment
    • EM Runs in the Family

      February 26, 2025 - 0 Comment
    • ACEP Clinical Policies Committee reviews Gastroenterology Guideline Update

      July 8, 2022 - 0 Comment

    Current Issue

    ACEP Now: June 2025 (Digital)

    Read More

    3 Responses to “How To Use Continuous Wall Suction for Paracentesis”

    1. October 22, 2015

      tyler Reply

      Tried this using the red cardinal suction canisters, which have liners. Could not get it to work. The liner gets sorta sucked up in the distal (patient) canister, and fluid kinda flows through it into the proximal (wall) canister, which fills up and cuts off suction at the valve. Is this brand dependent?

      • October 23, 2015

        Jordan Jeong Reply

        Hey Tyler, I think I’m following what you are describing but I do not believe it is brand dependent as we use the blue cardinal suction canisters. However we don’t have/use soft liners. This may be causing your issue. Although as long as the tubes are hooked up to the correct ports it should work. I’d like to help you get this working though. I use it all the time and it makes life much easier for me at least.

    2. March 10, 2019

      Angel Farro Reply

      Hello, I am a emergency medicine physician from Perú, and my question is about the proped pressure of the suction that you recommend, and the time when a volume of 5 liters can be extracted. Thank you.

    Leave a Reply Cancel Reply

    Your email address will not be published. Required fields are marked *


    *
    *

    Wiley
    • Home
    • About Us
    • Contact Us
    • Privacy
    • Terms of Use
    • Advertise
    • Cookie Preferences
    Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 2333-2603