Procedure in which excess fluid (ascites) accumulated in the abdominal cavity is drained through a thin catheter. Provides rapid relief of breathing difficulty and abdominal distention.
Indication
- Refractory ascites due to cirrhosis or heart failure (large-volume fluid accumulation)
- Breathing difficulty or increased intra-abdominal pressure caused by ascites
- Suspected spontaneous bacterial peritonitis (SBP) — diagnostic sample collection
- Symptomatic treatment of malignancy-related (tumor-related) ascites
- Biochemical and cytological examination for diagnostic purposes
- Diuretic-resistant (refractory) ascites
Preparation
- Determination of fluid amount and appropriate entry site by ultrasonography before the procedure
- Coagulation tests (INR, platelets) are checked
- The bladder is emptied
- Blood thinners are adjusted with physician approval
- Vital signs are recorded before the procedure
How it's performed
- The patient lies supine with a slight side-tilt position
- Abdominal skin is cleaned with antiseptic and a sterile drape is applied
- Skin and abdominal wall are numbed with local anesthesia
- A thin catheter is placed into the abdominal cavity under ultrasound guidance
- Fluid is drained at a controlled rate (generally 4-6 liters maximum in a single session)
- Albumin replacement (approximately 6-8 g per liter) is administered for high-volume drainage
Post-procedure
- Observation under monitoring for 2-4 hours after the procedure
- Vital signs and urine output are monitored
- Renal function check after albumin replacement
- If leakage occurs at the entry site, simple dressing is sufficient
- Follow-up of the underlying disease (cirrhosis, heart failure) is continued
Risks
- Fluid leakage from the entry site (most common)
- Bleeding or abdominal wall hematoma (rare)
- Bowel or bladder injury (very rare, minimized with ultrasound)
- Risk of infection (low with sterile technique)
- Circulatory dysfunction after large-volume drainage (prevented with albumin replacement)
FAQ
Is the procedure painful?
After local anesthesia, the procedure is generally painless. There may be a mild sensation of pressure.
How long does it take?
It varies depending on the amount of fluid but generally takes 30-60 minutes.
Will it need to be repeated?
Depending on the underlying disease, ascites may reaccumulate; recurrent paracentesis may be needed.
Can I be discharged the same day?
If there are no complications, discharge is generally possible after a few hours of observation.
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