- •Paracentesis relieves symptoms and improves outcomes in patients with ascites.
- •Paracentesis can be performed at the bedside.
- •Complication rates are low, but albumin must be used in cirrhotic ascites to prevent kidney injury.
- •Correct removal technique reduces incidence of leak after removal.
Ascites refers to the collection of fluid in the abdomen. This occurs as a result of several disease processes, including cirrhosis, heart failure, and malignancy. Ascites refractory to fluid restriction and diuretics is commonly managed with regular abdominal paracentesis. This review provides an overview of the indications for paracentesis, complication rates, correct performance of the procedure, drainage of fluid, removal of the drain, and minimization of complications.
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- Optimal management of ascites.Liver Int. 2020; 40: 128-135https://doi.org/10.1111/liv.14361
- Ascites, or fluid in the belly, in patients with cancer.JAMA Oncol. 2020; 6: 308https://doi.org/10.1001/jamaonc01.2019.5409
- Differential diagnosis of ascites in internal medicine: clinical case.Ter Arkh. 2018; 90: 74-80https://doi.org/10.26442/terarkh201890874-80
- Cardiac tamponade physiology secondary to tense ascites.Cardiology. 2016; 134: 423-425https://doi.org/10.1159/000445048
- Clinical outcomes after bedside and interventional radiology paracentesis procedures.Am J Med. 2013; 126: 349-356https://doi.org/10.1016/j.amjmed.2012.09.016
- Paracentesis.StatPearls Publishing, 2021https://www.ncbi.nlm.nih.gov/books/NBK435998/Date accessed: May 19, 2022
- Oxford Handbook Of Clinical Medicine.10 ed. Oxford University Press, 2017
- Six-minute walk test before and after large-volume paracentesis in cirrhotic patients with refractory ascites: a pilot study.Arab J Gastroenterol. 2019; 20: 81-85https://doi.org/10.1016/j.ajg.2019.05.009
- Reduction of abdominal pressure in patients with ascites reduces gastroesophageal reflux.Dis Esophagus. 2003; 16: 77-82https://doi.org/10.1046/j.1442-2050.2003.00303.x
- The benefit of paracentesis on hospitalized adults with cirrhosis and ascites.J Gastroenterol Hepatol. 2016; 31: 1025-1030https://doi.org/10.1111/jgh.13255
- Risk of complications after abdominal paracentesis in cirrhotic patients: a prospective study.Clin Gastroenterol Hepatol. 2009; 7: 906-909https://doi.org/10.1016/j.cgh.2009.05.004
- Severe haemorrhage following abdominal paracentesis for ascites in patients with liver disease.Aliment Pharmacol Ther. 2005; 21: 525-529https://doi.org/10.1111/j.1365-2036.2005.02387.x
- Paracentesis-induced circulatory dysfunction: a primer for the interventional radiologist.Semin Intervent Radiol. 2014; 31: 276-278https://doi.org/10.1055/s-0034-1382799
- Paracentesis-induced circulatory dysfunction with modest-volume paracentesis is partly ameliorated by albumin infusion in acute-on-chronic liver failure.Hepatology. 2020; 72: 1043-1055https://doi.org/10.1002/hep.31071
- Paracentesis for the management of ascites 1.2.Nepean Blue Mountains Local Health District, 2019
- A recommendation against the use of dilation for ultrasound-guided paracentesis.Chest. 2019; 155: 1304-1306https://doi.org/10.1016/j.chest.2019.02.336
- Evaluation of hospital complications and costs associated with using ultrasound guidance during abdominal paracentesis procedures.J Med Econ. 2012; 15: 1-7https://doi.org/10.3111/13696998.2011.628723
- Where should ascitic drains be placed? Revisiting anatomical landmarks for paracentesis.Gut. 2021; 70: 2216-2217https://doi.org/10.1136/gutjnl-2020-323731
- Feasibility of sonographic localization of the inferior epigastric artery before ultrasound-guided paracentesis.Am J Emerg Med. 2015; 33: 1795-1798https://doi.org/10.1016/j.ajem.2015.06.067
- Paracentesis.N Engl J Med. 2006; 355: e21https://doi.org/10.1056/NEJMvcm062234
- Albumin: indications in chronic liver disease.United European Gastroenterol J. 2020; 8: 528-535https://doi.org/10.1177/2050640620910339
- No evidence of benefit of routine ascitic fluid analysis in refractory ascites undergoing therapeutic paracentesis.Eur J Gastroenterol Hepatol. 2021; 33: 942https://doi.org/10.1097/meg.0000000000002119
- Oxford Handbook of Clinical Examination and Practical Skills.2 ed. Oxford University Press, 2014
- The Royal Marsden Hospital Manual of Clinical Nursing Procedures.9th ed. Wiley-Blackwell, 2015
- NSW Agency for Clinical Innovation. Paracentesis.(Accessed March 28, 2922)
- Guidelines on the management of ascites in cirrhosis.Gut. 2006; 55: vi1-vi12https://doi.org/10.1136/gut.2006.099580
Brendan Smith-Hanratty RN MN, PGCert, is a clinical nurse educator with Nepean Blue Mountains Local Health District, Katoomba, New South Wales, Australia, and can be contacted at [email protected]
Published online: February 03, 2023
In compliance with standard ethical guidelines, the author reports no relationships with business or industry that would pose a conflict of interest.
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