Abdominal Paracentesis

Indications

• The diagnosis of ascites of uncertain origin
• The relief of symptoms in ascites.

Precautions

Pregnancy, bleeding diathesis and hepatic precoma render the procedure hazardous.

• Premedication is rarely necessary and should be avoided when liver disease is suspected.
• Prior to the procedure, the patient should empty the bladder.
• Do not remove more than 1 liter of ascitic fluid at a time or more than 2 liters per 24 hours.
• Replace protein losses with salt-poor albumin or plasma infusion daily to avoid a hazardous reduction of the plasma volume.

Technique

Diagnostic and Therapeutic Paracentesis

• Empty bladder prior to paracentesis
• Avoid sites of previous surgery and the inferior epigastric vessels (use either iliac fossa at a point one-third of the distance from the anterior superior iliac spine to the umbilicus)
• Under strict aseptic precaution, cleanse the skin at the chosen site with antiseptic solution.
• Infiltrate the overlying skin and deeper tissues down to and including the peritoneum with 1% plain lignocaine
• Using a 50 ml syringe and a 19G needle, aspirate fluid, if necessary, by rolling the patient from the supine position towards the side of aspiration
• Send fluid for microbiological/cytological studies
• Use a zigzag approach through the layers of abdominal wall when tense ascites is present to avoid leakage of fluid after the procedure
• Do not remove more than 1 liter at a time or more than 2 liters of ascites each day and restore the plasma volume using salt-poor albumin or plasma.Abdominal Parenthesis

Site of choice—midway between anterior superior iliac spine and umbilicus.