Just a quick tip today, which I picked up from our current fellow Dr. Kevin Gurysh. Prior to doing a paracentesis, most of us will perform a quick POCUS exam to identify the largest pocket of fluid and get a sense of how deep it is. Kevin, however, takes it one step forward to increase the safety of his procedures.
After identifying the largest pocket of fluid, freeze the image and place two calipers. The first caliper goes from the skin to the peritoneum, which indicates the minimum distance the needle needs to traverse before entering the ascites pocket. The second caliper goes from the skin to the bottom of the pocket, which indicates the absolute hard limit of depth. The ideal needle length (or depth of insertion) is somewhere between these two depths.
To take it even one step further, one could take a second still with measurements of the same spot under compression, as this will often happen while inserting a large-bore needle.
What about you? Any tips or tricks you’d like to share? Let us know in the comments below, or hit us up on Twitter or Facebook!