Which department performs paracentesis (percutaneous abdominal paracentesis) in a hospital?

From the Guidelines

Paracentesis in a hospital can be safely performed by non-physician healthcare providers such as GI endoscopy assistants and specialist nurses who have undergone training to achieve competence in performing therapeutic paracentesis. According to the guidelines on the management of ascites in cirrhosis published in Gut in 2021 1, an efficient paracentesis service can be provided in a day case or outpatient setting. The training for non-physician healthcare providers can be completed with 10 supervised procedures, as indicated by exemplar training programmes.

Key Points to Consider

• The procedure should be performed with informed consent from the patient.
• Ultrasound can be used to identify a suitable site for drain insertion, such as the left lower quadrant abdominal wall, which is thinner and has a greater depth of ascites.
• To minimize the risk of injury, the point of puncture should be at least 8 cm from the midline and 5 cm above the symphysis.
• All ascitic fluid should be drained to dryness in a single session as rapidly as possible over 1–4 hours.
• After the procedure, the patient should lie on the opposite side for 2 hours if there is leakage of any remaining ascitic fluid, and/or a suture (ideally purse-string) inserted around the site of drainage, as recommended by the guidelines 1.

Service Provision

The service can be led effectively by non-physician healthcare providers, and the mean duration of the procedure is approximately 97±24 min, with a mean volume of ascitic fluid removed of 8.7±2.8 L, as reported in the study 1.

From the Research

Services Performing Paracentesis in a Hospital

• The services that perform paracentesis in a hospital include:
  • Interventional Radiology (IR) 2
  • Internal Medicine 2
  • Family Medicine 2
  • Gastroenterology/Hepatology 2
• These services may perform paracentesis procedures on patients with liver disease, ascites, or other conditions that require the removal of fluid from the abdominal cavity.

Frequency of Paracentesis Performance by Specialty

• According to one study, IR performed 29% of paracenteses, while medicine and medicine subspecialties (including gastroenterology/hepatology) performed 49% 2.
• Another study found that internal medicine- and family medicine-trained clinicians frequently perform paracentesis procedures on complex inpatients 2.

Outcomes and Quality Metrics

• Early paracentesis (within 1 hospital day) has been associated with reduced inpatient mortality, SBP-related mortality, and 30-day readmission 3.
• Paracentesis is underused for patients admitted to the hospital with ascites, and the procedure is associated with increased short-term survival 4.
• The performance of paracentesis may be used as a quality metric to evaluate the care of patients with cirrhosis and ascites 3, 4.