Who typically performs a paracentesis?

Who Typically Performs Paracentesis

Paracentesis is performed by a wide range of clinicians including internal medicine physicians, gastroenterologists/hepatologists, emergency physicians, interventional radiologists, and trained nurses, with the procedure being safe and appropriate for bedside performance by properly trained clinicians across these specialties. 1, 2, 3

Specialty Distribution in Clinical Practice

Academic Medical Centers

• Internal medicine and medicine subspecialties (including gastroenterology/hepatology) perform 49% of paracentesis procedures at university hospitals, while interventional radiology performs 29% 3
• The remaining procedures are distributed among other specialties including emergency medicine 4, 3

Emergency Department Settings

• Emergency physicians commonly perform ultrasound-guided paracentesis with a success rate of 97.7% when using real-time ultrasound guidance 4
• Emergency physicians with training in real-time needle guidance demonstrate high procedural success rates with no fatal complications 4

Nursing Role

• Trained nurses can safely perform paracentesis in patients with stable cirrhosis and deranged coagulation parameters (mean platelet count 50.4 × 10⁹/L, mean INR 1.7) with no reported bleeding events 1
• Nurses typically monitor patients throughout the procedure, administer treatment as directed, and may remove the drain depending on local policy 5

Factors Influencing Specialty Selection

Patient Characteristics Associated with IR Referral

• Female gender, higher body mass index, and lower volume of ascites removed predict higher probability of interventional radiology referral 2, 3
• Patients who are obese and those with lower severity of illness are more likely to be referred to IR 3

Clinical Outcomes by Specialty

• Bedside paracentesis results in equal or better patient outcomes compared to IR-performed procedures 2
• Patients undergoing bedside procedures have 1.86 fewer hospital days compared to IR referrals 2
• Hospital costs are $1,308 less for medicine-performed procedures and $803 less for gastroenterology/hepatology-performed procedures compared to IR 3
• Platelet and fresh frozen plasma transfusions are more common with IR procedures (OR 4.56 and OR 4.07, respectively), as are subsequent ICU transfers (OR 2.21) 2

Training and Competency Considerations

Current Training Gaps

• Paracentesis competency is not required for internal medicine or family medicine board certification, despite these specialties frequently performing the procedure on complex inpatients 3
• The decision to perform paracentesis at bedside versus IR is largely discretionary rather than evidence-based 2

Safety Profile Across Specialties

• The procedure is generally safe regardless of specialty when performed by trained clinicians, with serious complications occurring in less than 1 in 1,000 procedures 1
• Success rates are high across specialties: 97.7% for emergency physicians using ultrasound guidance and similar rates for bedside medicine procedures 4, 2

Common Pitfalls

• Unnecessary referral to IR increases hospital length of stay and costs without improving patient outcomes 2, 3
• Lack of formal training requirements means internal medicine and family medicine physicians may not develop competency despite frequently encountering patients requiring paracentesis 3
• Routine use of blood products before paracentesis is not evidence-based and adds unnecessary cost and risk, regardless of which specialty performs the procedure 1