A Nursing Story: The Paracentesis

My patient had liver failure.

A lot of bad things happen with liver failure; one of them is a tight swollen belly. The liver isn’t producing proteins properly so fluid seeps out of the blood vessels, filling up the abdominal cavity, making the belly drum-like, firm and distended. We call the condition ascites. 

Ascites can be very uncomfortable, making it hard to breathe, even hard to move, so we do a procedure called a paracentesis. The doctors stick a needle into the belly and siphon the pale yellow fluid out, often great quantities of it. Like: two, four, six liters at a time. Yes, the fluid just builds up again. A patient with liver failure will likely need multiple paracenteses. There’s a lot of fluid in there.

My patient had undergone a bunch of these procedures in the past week. His belly, still stubbornly swollen, was covered with bandaids from all the needle pricks.

That particular morning, I was helping my aide change his linens. I had turned him towards me and was firmly bracing him with my body so he wouldn’t roll all the way out of bed. His swollen abdomen pressed against me as the aide washed his back and placed fresh sheets on the bed.

You know when you sense that something isn’t quite right?

Maybe there’s a faint tickle, a soft sound, a fleeting shadow – something that barely registers, something that makes you take a casual glance around – and you discover something awful, something you didn’t expect? And then, due to circumstances, you can’t shriek or recoil or faint, but you have to calmly carry on with a straight face, as if nothing were amiss?

Nurses and aides know what I’m talking about. Parents, too.

As I held my patient snugly against me, I became faintly aware that my thighs felt odd. Cold, maybe, or – I don’t know, something. Different somehow.

So I glanced down.

One can encounter some unpleasant things in the hospital. But usually the event is over there, on someone else. Not on yourself.

When I glanced casually down, I made the unhappy discovery that my patient’s bodily fluids were pouring all over me.

Holding him tightly against me was like squeezing a water bladder full of pinprick holes: the pressure caused fluid to be forced out through his paracentesis sites. He was leaking – no, actively squirting – abdominal fluid. Right onto me.

The bottom of my scrub top was already soaked. The contents of my pockets – packets of gauze, rolls of tape, alcohol pads – were a total loss, wet and soggy. His fluid saturated my scrub pants, and was now running freely down my legs, rivulets of ascites fluid trickling down my skin like raindrops down a window.

And I had to just stand there, holding him firmly against me. I couldn’t let go, or he’d fall out of bed.

Tip to new nurses: You can borrow clean scrubs from your Surgery or OB department. At some point in your career, you will need to change your clothes.

I looked up and stared helplessly at my aide, then said in a strained voice, “Are you almost done?”

“Is everything okay?” my patient asked.

“Oh yes, everything’s fine,” I answered as breezily as possible, patting his back reassuringly as I felt more fluid dribble down my leg. He was, after all, getting a complimentary paracentesis. Free of charge!

It was on me.


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