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Randy,

I do perform diagnostic paracentesis and as a program director, encourage our fellows to do the same. Although not included in the list of procedures outlined in the July 2007 update to the RRC guidelines for PEM subspecialty training, it is within the scope of our practice. For instance, this list also includes peritoneal lavage, which as you know, is rarely performed in the setting of blunt trauma. 

The typical scenario for a diagnostic peritoneal tap is the "nephrotic" with suspected SBP in whom, obtaining ascitic fluid cell counts & cultures prior to ABX administration, is extremely helpful for ongoing management by our nephrologists. More recently, with the availability of bedside US, we can confirm presence of free intraperitoneal fluid prior to needle insertion. 

Along the same vein, I also encourage our fellows to perform suprapubic bladder punctures on infants in whom bladder catheterization is difficult.     

Hope that helps.

Jay (Pershad)
Le Bonheur Children's Medical Ctr.

SEE BELOW 

-------------- Original message from "Cordle, Randy" 
<[log in to unmask]>: -------------- 


> I am curious as to how many Children's Emergency Department Medical 
> Directors would expect their EP attending staff to routinely personally 
> perform paracentesis on children younger than 5 years of age. Could you 
> respond to me personally with the following information. 
> 
> 1. Name of CED: _Le Bonheur__________________________. 
> 2. EPs are expected to personally provide diagnostic paracentesis on 
> children <5 in the CED. [Not expected but routinely perform them to facilitate 
patient care]
> 3. Diagnostic paracentesis is performed by interventional radiology: 
> Never 
> 
> 4. Our EPs personally perform approximately 0-2 #(please don't 
> exaggerate here :)) diagnostic paracentesis in children <5 years old per 
> year. (Do not include those actually performed by another service) 
> 5. Our graduating PEM Fellows have documented 1-2 # (on average) 
> diagnostic paracentesis during their fellowship. 
> 
> Thanks, 
> Randy Cordle MD 
> [log in to unmask] 
> 
> Medical Director: Division of Pediatric Emergency Medicine 
> Fellowship Director: PEM Fellowship 
> Carolinas Medical Center 
> 

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The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html