Abdominal Paracentesis
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
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.