Paracentesis Reference Links
- Determine the cause of new onset ascites, ascites of unknown origin, or suspected malignant ascites
- Suspicion of bacterial peritonitis in a patient with known ascites with associated pyrexia, hypotension, tachycardia or encephalopathy.
- Remove excess intraperitoneal fluid to assist respiration and provide symptomatic relief.
- Problems at proposed puncture site
- Local skin infection/cellulitis; abdominal hernia; caput medusae or superficial veins
- Suspected abdominal adhesions or loculated collections of fluid
- Significant bowel distension.
- Uncooperative patient
- Uncorrected bleeding diathesis
- Note: Paracentessis can be safely performed with INR <8 and platelets >20
- Preprocedure bloods are not routine for those undergoing repeated therapeutic paracentesis
- Volume replacement and hemodynamic shifts following paracentesis are highly controversial.
- Colloid infusion is considered strictly optional for paracentesis of more than 5 L and is generally no longer recommended for paracentesis of lesser volume
- “6L has been removed in 15 min without negative consequences”
- Vila MC, Coll S, Sola R, et al: Total paracentesis in cirrhotic patients with tense ascites and dilutional hyponatremia. Am J Gastroenterol 1999; 94:2219. [Reference]
- Runyon BA: Management of adult patients with ascites caused by cirrhosis. Hepatology 1998; 27:264. [Reference]
- Runyon BA: Patient selection is important in studying the impact of large-volume paracentesis on intravascular volume. Am J Gastroenterol 1997; 92:371.
- USS guided paracentesis should be used in patients who are pregnant, have multiple abdominal scars or a history of bowel adhesions
- Best site of entrance for repeat paracentesis and therapeutic volume to be removed is determined by the patient’s prior experience, so these should be asked of the patient
- No aspiration
- Re-percuss the abdomen and try again. If still unsuccessful, request USS.
- No drainage
- Kinked or blocked tube: untwist and flush with sterile saline.
- Drain not secured properly and no longer in peritoneum: remove drain and re-site.