II. Indications

  1. Symptomatic relief in Cirrhotic Ascites
  2. Diagnostic study
    1. Suspected Spontaneous Bacterial Peritonitis
    2. Examine ascitic fluid for other etiology

III. General

  1. Remove up to 4-5 L ascitic fluid
  2. Salt-poor albumin
    1. Indicated post-procedure if >5 liters removed
    2. Preparation: 25% 50 cc bottle IV
    3. Dosing
      1. 1 bottle for every 1.5L of ascitic fluid removed or
      2. 8-10 grams per liter of fluid removed

IV. Labs

  1. Prior to procedure
    1. Complete Blood Count
    2. ProTime
    3. Partial Thromboplastin Time
  2. If Platelets <40,000 then
    1. Transfuse 6 pack of Platelets before Paracentesis
    2. Consider Benadryl 50 mg IV, 30 min before Platelets

V. Procedure

  1. Preparation
    1. Place Foley and empty Bladder before procedure
    2. Patient at 30 degrees head up (reverse Trendelenburg)
  2. Sites
    1. Avoid the rectus sheath
    2. Midline at Linea Alba
      1. Midline at approximately 2 cm below Umbilicus
    3. Lower quadrants (RLQ or LLQ) lateral to rectus sheath
      1. Perform under Ultrasound guidance
  3. Prepare site
    1. Clean and prep site well
      1. Spontaneous Bacterial Peritonitis risk
    2. Local 1% Lidocaine Anesthetic
  4. Paracentesis
    1. Use 22 gauge needle with catheter
    2. Consider Z-Tracking needle on entry into Abdomen
    3. Use vacuum bottle to apply suction
  5. Labs to send ascitic fluid
    1. Cytology (if malignancy suspected)
    2. Cultures (rule-out SBP)
      1. Rule-out Spontaneous Bacterial Peritonitis
    3. Neutrophils (PMNs)
      1. Suggests Spontaneous Bacterial Peritonitis if >250/mm3 in Cirrhotic Ascites
    4. Serum-to-Ascites Albumin Gradient (SAAG)
      1. Subtract ascitic fluid albumin from Serum Albumin
      2. SAAG >1.1 g/dl suggests Portal Hypertension

VI. Management: Post-Procedure in Cirrhosis

  1. Always send ascitic fluid for culture and PMN Count
    1. In Cirrhotic Ascites, 40% of patients are asymptomatic of Spontaneous Bacterial Peritonitis
  2. Up to 4-6 liters may be safely removed per Paracentesis without albumin replacement
    1. Risk of Paracentesis-induced circulatory dysfunction (PICD) with >6 Liter Paracentesis
    2. Replace albumin if >6 Liters are removed

VII. Adverse Effects

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Related Studies

Ontology: Paracentesis (C0034115)

Definition (SCTSPA) Punción de un espacio con aspiración de su contenido
Definition (SNOMEDCT_US) A puncture into a space with an aspiration of that space
Definition (NCI_NCI-GLOSS) A procedure in which a thin needle or tube is put into the abdomen to remove fluid from the peritoneal cavity (the space within the abdomen that contains the intestines, the stomach, and the liver).
Definition (MSH) A procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument.
Concepts Health Care Activity (T058)
MSH D019152
SnomedCT 86088003
English Paracenteses, Paracentesis, abdominal tapping, Paracentesis NOS, paracentesis, Puncture and drainage, Puncture and aspiration, Centesis, Needling and drainage, Tap, Centesis (procedure), Centesis, NOS
Dutch paracentesis NAO, paracentese, Paracentese
French Paracentèse SAI, Paracentèse
German Parazentese NNB, Parazentese, Stichinzision
Italian Paracentesi NAS, Paracentesi
Portuguese Paracentese NE, Paracentese
Spanish Paracentesis NEOM, centesis (procedimiento), centesis, paracentesis, punción con aguja y drenaje, punción y aspiración, punción y drenaje, Paracentesis
Japanese 穿刺NOS, 穿刺, センシ, センシNOS
Swedish Paracentes
Czech paracentéza, Paracentéza, Paracentéza NOS
Finnish Parasenteesi
Croatian Not Translated[Paracentesis]
Polish Paracenteza, Paracentesis, Nakłucie jamy ciała
Hungarian Paracentesis, Paracentesis k.m.n.
Norwegian Parasentese, Paracentese