UMEM Educational Pearls

Category: Procedures

Title: Paracentesis

Keywords: Paracentesis (PubMed Search)

Posted: 9/21/2008 by Michael Bond, MD (Updated: 2/24/2020)
Click here to contact Michael Bond, MD

Paracentesis:

Since we have covered so many other procedures I though I would include paracentesis for completion.

A diagnostic paracentesis (typically 30-60 ml)  is indicated to:

  • Determine etiology of new ascites (transudate vs exudate, cancer, infection)
  • Rule out spontaneous bacterial peritionitis...(suspect this in any patient with a history of ascites that has fever, mental status changes, or diffuse abdominal pain)

A therapeutic paracentesis (large volume >1L) is indicated in the emergency department for:

  • Respiratory distress from abdominal distension
  • Abdominal compartment syndrome.  See Dr. Winters Pearl

Remember large volume paracentesis can result in profound fluid shifts and subsequent hypotension.

Absolute Contraindications to paracentesis include:  Acute abdomen requiring surgery

Relative contraindications are:

  • Platelets <20,000
  • INR > 2
  • Pregnancy
  • h/o adhesions
  • abdominal wall cellulitis (just don't stick the needle through the cellulitis)
  • Distended bowel or bladder

To view a video on how to do a paracentesis please visit the New England Journal of Medicine http://content.nejm.org/cgi/content/short/355/19/e21

Next I will address how to interpret the paracentesis fluid results.