From the Guidelines
For a complicated paracentesis with leaking fluid, the most effective approach is to apply direct pressure to the site for 5-10 minutes using sterile gauze, and if leakage persists, place a purse-string suture around the site, as recommended by guidelines on the management of ascites in cirrhosis 1. To manage the leakage, consider the following steps:
- Apply direct pressure to the site for 5-10 minutes using sterile gauze.
- If leakage persists, place a purse-string suture around the site or apply a colostomy bag to collect drainage.
- For larger leaks, consider a single interrupted suture with 3-0 or 4-0 nylon.
- Apply a pressure dressing with sterile gauze and transparent adhesive dressing, changing it when saturated.
- Monitor for signs of infection including redness, warmth, increasing pain, or purulent drainage.
- Patients should limit physical activity for 24 hours post-procedure.
- If leakage continues beyond 72 hours, reassess for potential complications like ascites under tension or procedural issues. It is also important to note that the use of albumin infusion after paracentesis can help prevent paracentesis-induced circulatory dysfunction (PICD) and reduce the odds of PICD by 61% 1. The key to preventing future leaks is to use proper technique, such as the Z-track insertion technique and lateral approach, rather than midline insertion, as well as using smaller gauge needles 1.
From the Research
Complications of Paracentesis
- Leaking fluid after paracentesis can be a complication, and it is essential to monitor patients closely during and after the procedure 2.
- The removal of a large volume of ascitic fluid can lead to circulatory dysfunction, and albumin infusion has been shown to reduce this risk 3.
Management of Ascitic Leak
- Paracentesis with saline-albumin reinfusion can be an effective management strategy for ascitic leaks, particularly in patients with postoperative ascites 4.
- Repeated paracenteses combined with human albumin replacement have been shown to be safe and effective for treating tense ascites, with a lower risk of complications compared to diuretic therapy 5.
Large-Volume Paracentesis
- Large-volume paracentesis can be therapeutic, and the focus should be on removing as much fluid as safely tolerated 6.
- The removal of at least 5L of ascitic fluid is considered large-volume paracentesis, and it can help reduce intra-abdominal pressure and relieve symptoms such as abdominal distention, pain, and dyspnea 2.
Role of Albumin Infusion
- Albumin infusion has been shown to reduce the incidence of postparacentesis circulatory dysfunction, hyponatremia, and mortality compared to alternative treatments 3.
- Albumin infusion is essential in patients undergoing large-volume paracentesis to prevent circulatory dysfunction and other complications 3.