paracentesis

Introduction

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

• ascitic fluid analysis to establish etiology of ascites
• diagnosis of peritonitis:
  • 25% of patients admitted to the hospital have evidence of peritonitis
  • laparoscopy with histologic analysis of biopsy specimens is more sensitive for tuberculous peritonitis
• abdominal distension* with
  • dyspnea
  • abdominal pain

* therapeutic removal of ascites fluid

Contraindications

• underlying coagulopathy is rarely a contraindication
• no data to support prophylactic fresh frozen plasma, factor VIIa, or four-factor prothrombin complex concentrate
• vitamin K may be useful if deficient

Laboratory

• see ascitic fluid analysis

Procedure

Preparation:

• sterile field
• gloves
• mask, gown, & hat not essential
• 60 cc syringe
• 1.5 inch 18-22 gauge needle
• 1 liter evacuated collection bottle
• sterile plastic tubing

Technique:

• site of insertion
  • below umbilicus, above bladder
  • midline or lateral to the inferior epigastric arteries
  • avoid vascular areas midline above umbilicus
  • avoid lung lateral above umbilicus
  • avoid areas adjacent to scar tissue
    • risk of hematoma secondary to blood vessel puncture
    • risk of perforated viscus adherent to surgical scar
• empty bladder before midline insertion
• Z track entry to prevent leakage of ascitic fluid when the needle is removed
  • retract skin cadually
  • insert needle
  • release skin when peritoneum is entered

Management

• albumin may be useful to delay recurrence of ascites
  • recommended if large volume (> 5 L) pracentesis

More general terms

• clinical procedure

Additional terms

• ascites
• ascitic fluid analysis
• portal hypertension