Gastroenterology Book

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Paracentesis

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  1. Indications
    1. Symptomatic relief in Cirrhotic Ascites
    2. Diagnostic study
      1. Suspected Spontaneous Bacterial Peritonitis
      2. Examine ascitic fluid for other etiology
  2. 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
  3. 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
  4. Procedure
    1. Preparation
      1. Place Foley and empty bladder before procedure
      2. Patient at 30 degrees head up (reverse Trendelenburg)
    2. Prepare site
      1. Midline at Linea Alba
        1. Midline at approximately 2 cm below Umbilicus
      2. Clean and prep site well
        1. Spontaneous Bacterial Peritonitis risk
      3. Local 1% Lidocaine anesthetic
    3. Paracentesis
      1. Use 22 gauge needle with catheter
      2. Consider Z-Tracking needle on entry into abdomen
      3. Use vacuum bottle to apply suction
    4. Labs to send ascitic fluid
      1. Cytology (if malignancy suspected)
      2. Cultures (rule-out SBP)
        1. Rule-out Spontaneous Bacterial Peritonitis
      3. Serum-to-Ascites Albumin Gradient (SAAG)
        1. Subtract ascitic fluid albumin from Serum Albumin
        2. SAAG >1.1 g/dl suggests Portal Hypertension
  5. Adverse Effects
    1. Hypotension
    2. Hyponatremia
    3. Bleeding

Paracentesis (C0034115)

Definition (MSH)A procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument.
Definition (NCI)Insertion of a thin needle or tube into the abdomen to remove fluid from the peritoneal cavity.
ConceptsHealth Care Activity (T058)
ICD954.91
EnglishCentesis, Needling and drainage, Paracenteses, Paracentesis, Puncture and aspiration, Puncture and drainage, Tap
Spanishcentesis, paracentesis, punción con aguja y drenaje, punción y aspiración, punción y drenaje, puncion con aguja y drenaje, puncion y aspiracion, puncion y drenaje
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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