la ponction d’ ascite

 

 

 

Module digestif

 

 

 

 

 

 

La ponction d’ ascite

 

 

I. Rappel d’anatomie – physiologie :

Le foie reçoit du sang d’une double origine ; par la veine porte ou par l’artère hépatique = système veineux porte. Lors d’une stase à ce niveau, mauvaise circulation, il y a une hyper pression dans ce système porte => hypertension portale.

Conséquences : Gradient de ponction qui augmente entre le système porte et système cave. Cette hypertension portale donnera lieu aux varices oesophagiennes ou à une production d’ascite, le foie et le rein sont surchargés => liquide dans l’abdomen au lieu d’être éliminé.

II. Définition :

L’ascite est un épanchement liquidien dans la grande cavité péritonéale. La présence d’ascite => une distension progressive de l’abdomen avec parfois un dépliement de l’ombilic. La quantité d’eau qui peut s’accumuler dans cette cavité peut aller de 6 à 8 litres.

Cette ascite est responsable chez le malade d’une prise de poids, d’une peau tendue et très lissée au niveau du ventre avec une circulation collatérale.

Le médecin utilise la percussion pour écouter une matité hydrique

Il existe 2 types d’ascite :

Une ascite par transsudation plasmatique

 

 

=> un liquide pauvre en protide du à l’hypertension portale . Exemple : la cirrhose hépatique

Une rétension d’eau due à l’insuffisance de fonctionnement du foie et du rein

Une ascite par exsudation plasmatique

 

 

=> un liquide riche en protides (attention Cancer)

Ce volume d’eau important peut entraîner des problèmes de respiration.

III. Le but et le principe :

1. 2 types de ponction :

Soit pour analyse du liquide Soit pour évacuer l’ascite

Geste technique simple à asepsie très rigoureuse, c’est un acte médical dans lequel l’infirmière participe.

2. Matériel :

1 trocart rose

1 aiguille à ponction

des compresses stériles

des antiseptiques

les tubes de prélèvement pour analyse biologique, cytologique et histologique

tubulures pour évacuation

1 antiseptique

1 anesthésie locale à la xylocaïne

 

3. Le déroulement du soin :

Installer le malade confortablement en décubitus dorsal

Lui demander s’il veut aller aux toilettes

Les règles d’asepsie doivent être rigoureusement suivies :

Médecin : gants stériles et asepsie de la zone de ponction avec compresses stériles

Il pique du côté gauche pour éviter le foie et parce que les anses sont moins superficielles à gauche

Ponction du liquide pour analyse et distribution dans les tubes

L’aiguille au niveau de l’abdomen doit être bien fixée, le malade ne doit pas bouger.

Si arrêt prévenir quelqu’un

Lors de l’évacuation de l’ascite : Regarder le liquide prélevé, prendre cte, TA, puls.

Clamper l’évacuation au bout de quelques litres

L’évacuation du liquide peut être longue => d’ou bonne installation

Mesurer l’abdomen avant et après la ponction

Pesée avant et après

Surveiller le débit, la couleur ( claire, trouble, hémorragique )

Noter le volume à signaler au médecin et à transcrire sur le dossier de soins

Toujours prendre les ctes

Ne pas mobiliser l’aiguille => rôle du médecin

Quand la ponction est terminée, retirer le tout et le jeter dans le dépôt sale

Poser un pansement sec sur le point de ponction

Dire au malade de se reposer et de rester couché

La ponction d’analyse est suivie d’une ponction d’évacuation

♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦

1. 2 types de ponction :

19 votes. Moyenne 2.68 sur 5.

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