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.
Catheter introduction over wire.