What type of specialist treats ascites and performs paracentesis to drain fluid?

From the Guidelines

Gastroenterologists and hepatologists are the primary specialists who treat ascites and perform paracentesis to drain excess fluid from the abdomen. These physicians specialize in diseases of the digestive system and liver, which are often the underlying causes of ascites 1. Paracentesis is a procedure where a needle is inserted through the abdominal wall to remove accumulated fluid for both diagnostic and therapeutic purposes. In hospital settings, interventional radiologists may also perform paracentesis, particularly when ultrasound guidance is needed for complex cases. Nephrologists might be involved in cases where ascites is related to kidney dysfunction, while general surgeons sometimes perform the procedure in emergency situations.

The choice of specialist often depends on the underlying cause of ascites, which commonly includes liver cirrhosis, heart failure, kidney disease, or cancer. Treatment typically involves addressing the root cause while managing symptoms through fluid drainage, dietary sodium restriction, and medications like diuretics (spironolactone and furosemide) to reduce fluid accumulation. According to the EASL clinical practice guidelines, large-volume paracentesis (LVP) is the treatment of choice for the management of patients with grade 3 ascites, and it is generally a safe procedure with a low risk of complications 1.

Some key points to consider when performing paracentesis include:

• The procedure should be performed under strict sterile conditions using disposable sterile materials 1.
• The left lower quadrant is the preferred location for needle insertion, as it has been shown to be thinner and with a larger pool of fluid than the midline 1.
• Coagulopathy should not preclude paracentesis, unless there is clinically evident hyperfibrinolysis or disseminated intravascular coagulation 1.
• The administration of albumin is the most effective method to prevent circulatory dysfunction after LVP, and it is more cost-effective than alternative plasma volume expanders 1.

Overall, the treatment of ascites and performance of paracentesis require a multidisciplinary approach, and the choice of specialist will depend on the individual patient's needs and underlying condition.

From the Research

Specialist for Ascites Treatment and Paracentesis

The specialist who treats ascites and performs paracentesis to drain fluid is typically a:

• Gastroenterologist 2, 3, 4
• Hepatologist 2, 4
• Interventional radiologist (for procedures like transjugular intrahepatic portosystemic shunt (TIPS)) 4, 5
• Surgeon (for procedures like peritoneovenous shunt) 3

Procedure and Care

Paracentesis is a procedure used to remove ascitic fluid from the abdominal cavity, and it is usually performed by a gastroenterologist or hepatologist 2, 3, 4. The role of the nurse is to monitor the patient throughout the procedure, administer treatment as directed by the medical team, and remove the drain at the end of the procedure 6.

Key Points to Consider

• Large-volume paracentesis (LVP) is the removal of at least 5L of ascitic fluid and is considered an effective treatment for ascites 2, 3, 4
• LVP can be performed repeatedly, but it may lead to circulatory dysfunction and renal impairment 2, 3, 5
• The use of albumin infusion during LVP can help prevent circulatory dysfunction and renal impairment 2, 3, 4
• Other treatment options for ascites include diuretics, peritoneovenous shunt, and TIPS 2, 3, 4
• Nurses play a crucial role in providing safe and effective care for patients undergoing paracentesis 6