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paracentesis

An invasive procedure consisting of insertion of a needle through the abdominal wall into the peritoneal cavity for the purpose of removing ascitic fluid for diagnostic or therapeutic reasons. Indications: 1) ascitic fluid analysis to establish etiology of ascites 2) diagnosis of peritonitis: a) 25% of patients admitted to the hospital have evidence of peritonitis b) laparoscopy with histologic analysis of biopsy specimens is more sensitive for tuberculous peritonitis 3) abdominal distension* with a) *dyspnea b) *abdominal pain * therapeutic removal of ascites fluid Contraindications: 1) underlying coagulopathy is rarely a contraindication 2) no data to support prophylactic fresh frozen plasma Procedure: Preparation: 1) sterile field 2) gloves 3) mask, gown, & hat not essential 4) 60 cc syringe 5) 1.5 inch 18-22 gauge needle 6) 1 liter evacuated collection bottle 7) sterile plastic tubing Technique: 1) site of insertion a) below umbilicus, above bladder b) midline or lateral to the inferior epigastric arteries c) avoid vascular areas midline above umbilicus d) avoid lung lateral above umbilicus e) avoid areas adjacent to scar tissue 1] risk of hematoma secondary to blood vessel puncture 2] risk of perforated viscus adherent to surgical scar 2) empty bladder before midline insertion 3) Z track entry to prevent leakage of ascitic fluid when the needle is removed a) retract skin cadually b) insert needle c) release skin when peritoneum is entered Laboratory: - see ascitic fluid analysis Management: - albumin may be useful to delay recurrence of ascites [2] - recommended if large volume (> 5 L) pracentesis [3]

Related

ascites ascitic fluid analysis portal hypertension

General

clinical procedure

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 367-68
  2. Bari K et al. The combination of octreotide and midodrine is not superior to albumin in preventing recurrence of ascites after large-volume paracentesis. Clin Gastroenterol Hepatol 2012 Oct; 10:1169 PMID: 22801062
  3. Garcia-Tsao G et al. AGA clinical practice update on the use of vasoactive drugs and intravenous albumin in cirrhosis: Expert review. Gastroenterology 2024 Jan; 166:202. PMID: 37978969 https://www.gastrojournal.org/article/S0016-5085(23)05143-0/fulltext