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Residency Program > Residency Program > Resident Resources > Ultrasound Guidance for Paracentesis

Ultrasound Guidance for Paracentesis

This video details how the use of bedside ultrasound imaging when performing paracentesis, as well as identifying ideal candidates for this procedure, mapping the internal jugular vein and ascites to determine an ideal puncture point, needle depth, and needle trajectory.

Last Updated on Thursday, August 26 2010 12:15  

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Scoring:
A: 5-6
B: 7-9
C: 10-15
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Serum sodium
Ideal sodium
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For ischemic CVA the heparin dosing is as follows: no bolus, and 600-1000 units/hr drip (not weight-based). For other indications, use the calculator below.
Heparin indication

(For ACS, strongly consider LMWH instead of unfractionated heparin. Also, if using a IIb/IIIa inhibitor with unfractionated heparin, dose the unfractionated heparin as though the patient has a STEMI.)
 
Patient sex
Weight
Height
Heparin dosing weight (kg)
Bolus dose
*
Initial drip rate
*


*Maximum doses:
VTE 9000 bolus, 2000/hr gtt
NSTEMI 5000 bolus, 1000/hr gtt
STEMI 5000 bolus, 1000/hr gtt


Patient's sex
Weight
 
Height
Weight (kg)
BMI
Ideal body weight (kg)


Patient sex
Patient age
African-American?
Serum creatinine
eGFR / 1.73 m2

Bilirubin
INR
Creatinine*
*If the patient has been dialyzed at least twice within the last week, enter "4.0" for the serum creatinine.
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Three-month mortality risk based on MELD Score:
Score
Mortality
‹10
4%
10-19
27%
20-29
76%
30-39
83%
40+
~100%

First drug
First drug dose (mg)
Second drug
Second drug dose (mg)

Note #1: Opioid analgesics have widely variable half lives, and when you switch from one form to another, you should adjust the scheduling accordingly.

Note #2: Methadone should be dosed by someone with experience using the drug. Consult palliative care or pain management.


QT (msec)
HR (bpm)
QTc (msec)


First steroid
Dose to convert (mg)
Second steroid
Second steroid dose (mg)

Age over 65
3 or more CAD risk factors
Prior coronary stenosis (50% or more)
ST segment deviation on initial ECG
2 or more anginal events in previous 24 hours
ASA use in last 7 days
Cardiac enzyme elevation
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TIMI Risk for cardiac event (mortality, new MI, or need for emergent revascularization) in the next 14 days:
 
Score
0-1
4.7%
 
2
8.3%
 
3
13.2%
 
4
19.9%
 
5
26.2%
 
6-7
40.9%
Serum potassium
Urine potassium
Serum osmolality
Urine osmolality
TTKG