From the Guidelines
Emergent paracentesis is indicated in patients with cirrhosis and ascites who are hospitalized emergently for any reason, or who develop signs suggestive of infection, including fever, abdominal pain, gastrointestinal bleeding, hepatic encephalopathy, hypotension, or renal insufficiency.
Indications for Emergent Paracentesis
- Patients with new-onset Grade 2 or 3 ascites
- Patients hospitalized for worsening ascites
- Patients with any complication of cirrhosis, including:
- Fever
- Abdominal pain
- Gastrointestinal bleeding
- Hepatic encephalopathy
- Hypotension
- Renal insufficiency
- Patients with tense ascites and acute kidney injury (AKI) to exclude spontaneous bacterial peritonitis (SBP) as a cause of AKI 1
Procedure and Analysis
- Diagnostic paracentesis should be performed as soon as possible in patients with suspected infection or complications of cirrhosis
- Ascitic fluid should be cultured at the bedside in aerobic and anaerobic blood culture bottles before initiation of antibiotics 1
- The diagnosis of SBP is established with a fluid polymorphonuclear (PMN) leukocyte count >250/mm3 1
Important Considerations
- Patients with severe coagulopathy, clinically evident hyperfibrinolysis, or disseminated intravascular coagulation should be approached with caution, and paracentesis may be contraindicated in these cases 1
- Pregnancy, severe intestinal distension, and a history of extensive abdominal surgery are relative contraindications for paracentesis 1
From the Research
Indications for Emergent Paracentesis
The following are indications for emergent paracentesis:
- New-onset ascites or known ascites with a change in condition, such as fever, abdominal pain, renal insufficiency, or encephalopathy 2
- Suspected spontaneous bacterial peritonitis, which is a common and serious complication of ascites 2
- Refractory or symptomatic ascites, where therapeutic paracentesis is performed to relieve symptoms 3
- Known liver disease and obvious ascites, as well as suspected ascites or suspected subacute bacterial peritonitis 4
- Shock without a known apparent cause, undiagnosed disease within the abdominal cavity, suspicion of postoperative gastrointestinal wound dehiscence, blunt or penetrating abdominal injury, and refractory abdominal pain for which a cause cannot be determined 5
- Severe abdominal distention, pain, and dyspnoea (difficulty breathing) due to ascites, where paracentesis is used to reduce intra-abdominal pressure and relieve symptoms 6
Diagnostic and Therapeutic Uses
Paracentesis is used for both diagnostic and therapeutic purposes, including:
- Characterizing the ascitic fluid and detecting infection 2
- Aiding in differential diagnosis 2
- Relieving symptoms of abdominal ascites, such as severe abdominal distention, pain, and dyspnoea (difficulty breathing) 6
- Reducing intra-abdominal pressure 6
- Diagnosing diseases with abdominal effusion, such as peritonitis, hemoperitoneum, uroabdomen, and neoplasia 5