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Paracentesis: Definition, Indications & Procedure Overview

Paracentesis (from Greek para = beside + kentesis = puncture) = surgical puncture of a body cavity to aspirate fluid. Most commonly refers to peritoneal cavity (abdominal paracentesis).

Indications

Diagnostic

  • New-onset ascites (determine etiology: SAAG, cell count, culture, protein, cytology)
  • Suspected spontaneous bacterial peritonitis (SBP)
  • Malignancy workup (cytology, tumor markers)

Therapeutic

  • Large-volume ascites causing respiratory compromise, abdominal pain, early satiety, hernia risk.
  • Refractory ascites (recurrent despite diuretics).

Procedure Outline

  1. Informed consent (risks: bleeding, infection, bowel perforation, hypotension).
  2. Pre-procedure: Bladder empty, labs (INR, platelets, CBC), ultrasound marking.
  3. Position: Supine or lateral decubitus.
  4. Site: Left lower quadrant (preferred), 2-3 cm medial to ASIS, avoiding inferior epigastric artery.
  5. Local anesthetic (1% lidocaine) → Z-track technique → catheter/needle insertion → fluid collection.
  6. Large-volume (>5L): Albumin infusion (6-8g/L removed) to prevent circulatory dysfunction.
  7. Post-procedure: Monitor vitals, site, send fluid for analysis.

Fluid Analysis Essentials

  • SAAG (Serum-Ascites Albumin Gradient): >1.1 g/dL = portal hypertension; <1.1 = non-portal (malignancy, TB, pancreatitis).
  • Cell count: >250 PMNs/mm³ = SBP (empiric antibiotics).
  • Culture: Blood culture bottles at bedside (increases yield).
  • Protein, LDH, glucose, amylase, cytology, tumor markers as indicated.

Ultrasound guidance strongly recommended – reduces complications, confirms fluid, avoids organs.

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