Paracentesis is performed in the intensive care unit (ICU) for
diagnostic or therapeutic purposes to drain free fluid from the
- ▪ Paracentesis: Aspiration of peritoneal fluid from
the abdomen (Figure 45-1).
- ▪ Peritoneal lavage: To be distinguished fromparacentesis—performed
to evaluate abdomen for free bleeding typically following trauma—has been
largely supplemented by ultrasound.
Graphic showing paracentesis aspiration
of peritoneal fluid.
- ▪ Indications:
- • To determine the etiology of ascites.
- • To diagnose infection in chronic ascites (ie,
spontaneous bacterial peritonitis).
- • To diagnose intra-abdominal malignancy.
- • To relieve respiratory distress due to ascites.
- • To decrease intra-abdominal pressure and improve
- ▪ Contraindications:
- —Acute abdominal process requiring surgical management
- —Skin cellulitis over proposed incision site
- —Distended bladder or bowel
- —Previous abdominal surgery with adhesions
- ▪ Ultrasound and/or physical examination (ie,
presence of a fluid wave) can be used to diagnose presence and/or
location of ascetic fluid.
- ▪ Prior to the procedure, patient consent should be obtained,
site should be prepped and draped, and universal protocol should
be performed as per Section I.
- ▪ The bladder and stomach should be emptied prior to performance
of the procedure.
- ▪ Technique:
- —Patient should be positioned supine or in
lateral decubitus position in order to bring free ascites below
proposed insertion spot as determined by examination or ultrasound.
- —Local anesthetic is infiltrated into skin over
proposed paracentesis site, typically paramedian (Figure 45-2) in
anterior axillary line or in midline below umbilicus.
- —A needle or Angiocath is inserted into the abdomen
and aspirated (Figures 45-3 and 45-4).
- —When free ascites fluid is obtained, a wire may
be introduced into needle or Angiocath according to Seldinger technique,
and a catheter introduced over the wire for fluid drainage (Figures 45-5, 45-6, 45-7, 45-8, and 45-9).
- —Samples of the fluid are sent for diagnostic studies
- ▪ Complications:
- —Gastric or bowel perforation
- —Post-paracentesis hypotension secondary to volume
- —Intra-abdominal bleeding
Infiltration of local anesthetic in skin wall along anterior
Needle introduction into abdominal wall.
Ascitic fluid aspiration.
Introduction of Seldinger exchange wire through needle
Needle withdrawal over wire.
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