Skip to Main Content




Paracentesis is performed in the intensive care unit (ICU) for diagnostic or therapeutic purposes to drain free fluid from the peritoneum.


Definitions and Terms


  • ▪  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.

Figure 45-1.
Graphic Jump Location

Graphic showing paracentesis aspiration of peritoneal fluid.




  • ▪  Indications:
    • —Diagnostic:
      • • To determine the etiology of ascites.
      • • To diagnose infection in chronic ascites (ie, spontaneous bacterial peritonitis).
      • • To diagnose intra-abdominal malignancy.
    • —Therapeutic:
      • • To relieve respiratory distress due to ascites.
      • • To decrease intra-abdominal pressure and improve venous return.
  • ▪  Contraindications:
    • —Coagulopathy
    • —Acute abdominal process requiring surgical management
    • —Skin cellulitis over proposed incision site
    • —Distended bladder or bowel
    • —Previous abdominal surgery with adhesions
    • —Pregnancy
  • ▪  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 as warranted.
  • ▪  Complications:
    • —Gastric or bowel perforation
    • —Peritonitis
    • —Post-paracentesis hypotension secondary to volume redistribution
    • —Intra-abdominal bleeding

Figure 45-2.
Graphic Jump Location

Infiltration of local anesthetic in skin wall along anterior axillary line.

Figure 45-3.
Graphic Jump Location

Needle introduction into abdominal wall.

Figure 45-5.
Graphic Jump Location

Introduction of Seldinger exchange wire through needle into abdomen.

Figure 45-7.
Graphic ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.