Abdominal Paracentesis

Procedure in which ascitic fluid accumulated in the abdomen is drained under sterile conditions and ultrasound guidance for diagnostic or therapeutic purposes; commonly performed in patients with liver cirrhosis.

Indication

• Determining the cause of new-onset ascites (diagnostic paracentesis)
• Screening for infection (spontaneous bacterial peritonitis) in cirrhosis patients with ascites
• Drainage of large-volume ascites causing breathing difficulty, abdominal distention, and pain (therapeutic)
• Diuretic-resistant (refractory) ascites
• Ascites due to intra-abdominal malignant tumors
• Ascites patients with unexplained fever and abdominal pain

Preparation

• Blood thinners are adjusted with physician approval; INR and platelet count are checked
• The bladder is emptied before the procedure
• An IV line is established; preparation for albumin support is made if a large volume will be drained
• A suitable entry point is identified using ultrasound
• Informed consent is obtained; allergies and medication history are reviewed

How it's performed

1. The patient is placed supine and tilted slightly to the left side
2. A safe entry point at the thickest area of ascites is identified with ultrasound, and the skin is sterilized
3. Local anesthesia is applied to the skin and subcutaneous tissue
4. A thin catheter or needle is inserted into the abdominal cavity to access the free fluid
5. If diagnostic, a 30-50 mL sample is collected; if therapeutic, controlled drainage is performed
6. When more than 4-6 liters of fluid is drained in a single session, 6-8 g of albumin is given per liter

Post-procedure

• Blood pressure, pulse, and entry site are monitored for 1-2 hours after the procedure
• If leakage occurs at the entry site, a simple suture or pressure dressing is applied
• Salt restriction (<2 g/day) and diuretic therapy are continued
• If ascites reaccumulates, the procedure may be repeated every 2-4 weeks
• Monitoring for infection until culture and cell count results from the fluid sample are available

Risks

• Transient ascitic leakage at the entry site (most common)
• Abdominal wall bleeding or hematoma
• Circulatory dysfunction after large-volume drainage (post-paracentesis circulatory dysfunction) — prevented with albumin
• Procedure-related infection, peritonitis (rare; minimized with sterility)
• Bowel or vascular injury (very rare, minimized with ultrasound guidance)

FAQ

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