Overview

Paracentesis is a procedure used to remove fluid from the peritoneal cavity for diagnostic evaluation or therapeutic relief of ascites.

Paracentesis is crucial for diagnosing the cause of ascites, relieving symptoms, and guiding treatment decisions in patients with liver disease or malignancy.

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Indications

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New Onset Ascites

Diagnostic evaluation

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Symptomatic Ascites

Therapeutic drainage

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Suspected Spontaneous Bacterial Peritonitis

Infection evaluation

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Malignant Ascites

Cytology analysis

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Refractory Ascites

Large volume paracentesis

Contraindications

Absolute Contraindications

✗ Patient refusal
✗ Coagulopathy
✗ Small ascites

Relative Contraindications

✗ Pregnancy
✗ Abdominal wall infection
✗ Multiple adhesions

📋 Equipment Checklist

Check off items as you gather them:

Pre-procedure Preparation

Preparation includes patient consent, imaging review, sterile technique, and equipment setup.

Step-by-Step Procedure

Step 1: Patient Preparation

Explain procedure, obtain consent, position patient.

⚠️ Common Mistakes to Avoid:

  • Inadequate consent
  • Poor positioning

💡 Pro Tip:

Position patient supine.

Step 2: Imaging Review

Review abdominal imaging.

⚠️ Common Mistakes to Avoid:

  • No imaging
  • Wrong site

💡 Pro Tip:

Use ultrasound guidance when available.

Step 3: Site Selection

Choose appropriate puncture site.

⚠️ Common Mistakes to Avoid:

  • Wrong site
  • Small ascites

💡 Pro Tip:

Select site with adequate fluid.

Step 4: Sterile Preparation

Prep and drape sterile field.

⚠️ Common Mistakes to Avoid:

  • Inadequate prep
  • Contamination

💡 Pro Tip:

Use strict sterile technique.

Step 5: Local Anesthesia

Infiltrate local anesthetic.

⚠️ Common Mistakes to Avoid:

  • Inadequate anesthesia
  • Wrong technique

💡 Pro Tip:

Anesthetize skin and peritoneum.

Step 6: Fluid Aspiration

Aspirate peritoneal fluid with proper technique.

⚠️ Common Mistakes to Avoid:

  • Wrong angle
  • Multiple attempts

💡 Pro Tip:

Use proper needle angle.

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Post-procedure Care

Post-procedure care involves monitoring for complications, specimen handling, and follow-up evaluation.

Complications & Management

Complication Incidence Signs Management Prevention
Bleeding 1-2% Hematoma, hypotension Pressure, transfusion Check coagulation
Infection 0.1-1% Fever, abdominal pain Antibiotics Sterile technique
Bowel perforation 0.1-1% Abdominal pain, peritonitis Surgery, antibiotics Proper technique
Hypotension 2-5% Dizziness, syncope IV fluids, albumin Limit fluid removal

Clinical Pearls

💡

Use ultrasound guidance when available.

🎯

Choose site with adequate fluid.

⚡

Limit fluid removal to 4-6L initially.

🔍

Send fluid for appropriate analysis.

📊

Monitor for complications.

🎨

Use strict sterile technique.

⚠️

Consider albumin replacement for large volumes.