Can You Use a Catheter Kit for Paracentesis?
Yes, a catheter kit can be used for paracentesis, and this approach has been successfully employed in clinical practice, particularly when dedicated commercial paracentesis kits are unavailable. 1
Evidence Supporting Catheter Kit Use
A published technique describes using a multiple lumen catheter (commonly used for central venous line insertion) for drainage of ascites, offering several advantages over standard needle or single catheter methods 1:
- Easier and more rapid aspiration of fluid due to multiple lumens 1
- Lower probability of side holes being blocked compared to single-lumen devices 1
- Particularly useful when dedicated commercial paracentesis kits are not readily available 1
Critical Sterility Requirements
Regardless of the catheter type used, strict sterile technique is mandatory for paracentesis 2:
- Maximal barrier precautions must be employed, including hand washing, sterile gowns, sterile gloves, caps, and masks covering both mouth and nose 2
- Chlorhexidine-containing solution should be used for skin preparation in adults 2
- Full-body patient drapes are required 2
- All equipment must be sterile and disposable 2
Practical Considerations When Using Catheter Kits
When adapting a catheter kit for paracentesis, ensure the following:
- Use a cannula with multiple side perforations to prevent blockage by bowel wall 3
- Insert at least 8 cm from midline and 5 cm above symphysis pubis, preferably in the left lower quadrant 3
- Employ the "Z-track" technique to ensure puncture sites on skin and peritoneum don't directly overlie each other 4, 3
- Use ultrasound guidance when available to reduce adverse events and improve success rates 2, 3, 5
Important Safety Warnings
Do not leave the catheter in place overnight 3. While indwelling catheters have been used for continuous drainage in malignant ascites 6, 7, this carries significant risks including:
- Catheter-related sepsis rate of 1.6 episodes per 100 catheter-days 6
- Fatal hypotension from rapid drainage (4.4% acute mortality in one series) 6
- Tube blockage and dislodgment requiring premature removal in up to 13.5% of cases 6
Albumin Replacement Protocol
When performing large-volume paracentesis with any catheter system:
- For volumes >5 liters: mandatory albumin replacement at 8 g per liter of ascites removed 2, 3
- Infuse albumin after paracentesis completion, not during the procedure 3
- Complete drainage over 1-4 hours at approximately 2-9 liters per hour 3
Common Pitfalls to Avoid
- Do not withhold paracentesis due to coagulopathy - routine correction of INR or platelet count is not recommended, even with INR >1.5 and platelets <50,000/μL 2, 3
- Do not artificially slow drainage rate out of concern for hemodynamic instability - this outdated practice is not supported by current evidence 3
- Do not use sutures for routine catheter stabilization - manufactured stabilization devices are preferred to reduce infection risk 2