Abdominal Paracentesis (Internal Medicine)

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  • Diagnosis of new-onset ascites
  • Evaluation for SBP
  • Admission surveillance paracentesis
  • Therapeutic drainage of tense ascites
  • Coagulation disorders
    • The use of fresh-frozen plasma or platelet concentrates is not recommended.
  • Abnormalities of the overlying skin.
  • Distended intra-abdominal organs
  • Intra-abdominal adhesions and surgical scars
  • Skin-cleansing agent (e.g., chlorhexidine or povidone-iodine)
  • Sterile gauze, drape, gloves
  • Local anesthetic (e.g. 1% lidocaine) (see Local Anesthesia for further details)
  • 5- to 10-mL syringe with a 25- and 22- gauge needle for injection of anesthetic
  • Needle and catheter assembly (2-inch, 18-gauge intravenous catheters without retractable needles or paracentesis-specific devices)
  • 35- to 60-mL syringe for aspiration of ascitic fluid
  • High-pressure drainage tubing
  • Specimen tubes
  • Evacuated containers (as many as five or more)
  • Sterile occlusive dressing
  • Bedside ultrasound machine (optional)
  • Needle entry sites
    • 2 cm below the umbilicus in the anatomic midline
    • RLQ or LLQ, 4 to 5 cm superior and medial to the anterior superior iliac spine

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  • Apply pressure to the site.
  • Monitor the patient after large-volume paracentesis.
  • Postparacentesis circulatory dysfunction
    • May occur after large-volume paracentesis (>5 L).
    • Albumin may be administered after large-volume paracentesis to prevent postparacentesis circulatory dysfunction.3,4,16
  • Persistent leakage of ascitic fluid
    • Use of the Z-tract technique may prevent this complication.
    • Placement of a single suture may stop the leak.7
  • Other complications are rare.1
  • The serum-ascites albumin gradient
    • SAAG values greater than 1.1 g/dL occur with portal hypertension.
  • Additional testing is required for patients with SAAG values lower than 1.1 g/dL.
  • Testing for spontaneous bacterial peritonitis
    • Ascitic fluid polymorphonuclear cell counts greater than 250/mm3 are indicative of SBP.3,4
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