Paracentesis
The procedure used for draining abdominal fluid during ascites is called paracentesis. 1, 2, 3
Terminology and Types
Paracentesis is the medical term for the transabdominal needle aspiration of fluid from the peritoneal cavity 4, 5
The procedure has two main applications:
Clinical Context
Large-volume paracentesis specifically refers to removal of ≥5 liters of ascitic fluid in a single session 1, 2, 4
Therapeutic paracentesis is first-line treatment for patients with large or refractory ascites causing symptomatic relief from abdominal distention, pain, and dyspnea 2, 3
The procedure can safely remove all ascitic fluid to dryness in a single session over 1-4 hours when appropriate albumin replacement is given 2, 3
Procedure Technique
The preferred site is the left lower quadrant, specifically 2 finger breadths (3 cm) cephalad and 2 finger breadths medial to the anterior superior iliac spine 3, 7
The "Z-track" technique should be used with a cannula containing multiple side perforations to prevent bowel wall blockage 2, 3
Strict sterile conditions are mandatory during the procedure 2, 3
Volume Expansion Requirements
For paracentesis >5 liters, albumin replacement is mandatory at 8 g per liter of ascites removed to prevent post-paracentesis circulatory dysfunction 2, 3
Albumin reduces circulatory dysfunction by 61%, mortality by 36%, and hyponatremia by 42% compared to alternative plasma expanders 3
For paracentesis <5 liters, synthetic plasma expanders may be used instead of albumin 2
Safety Profile
The only absolute contraindication is clinically evident hyperfibrinolysis or disseminated intravascular coagulation 3, 7
Coagulopathy is NOT a contraindication—the procedure can be safely performed despite elevated INR or low platelet counts without prophylactic transfusions 3, 7, 5
Severe hemorrhage occurs in only 0.2-2.7% of procedures, with a death rate of 0.02% (1 in 5,000 procedures) 3