Chapter 12 Paracentesis
INTRODUCTION
A myriad of clinical conditions can lead to the development of ascites. Abdominal paracentesis is both diagnostic and therapeutic and can aid in the differential diagnosis. Although in the United States, the majority of cases are now caused by alcoholic liver disease, other common causes include infection, malignancy, congestive heart failure, and nephrotic syndrome. Paracentesis allows the peritoneal fluid to be sent for analysis. The fluid is considered sterile if there are fewer than 250 polymorphonuclear leukocytes/mm3.1
For patients with new-onset ascites, a useful calculation is the serum–ascites albumin gradient (SAAG), which can help distinguish between some of the more common etiogies.2 Paracentesis can also be useful to evaluate a patient with known ascites for the development of spontaneous bacterial peritonitis.
Not only is paracentesis a critical diagnostic tool, but it also provides therapeutic benefit. Ascites can cause sequelae ranging from early satiety, abdominal pain, fullness, and umbilical hernias to shortness of breath and adverse effects on cardiovascular function.3,4 Paracentesis has been shown to remove ascitic fluid more rapidly than diuretics,5 thus providing symptomatic relief for the patient.
OPERATIVE PROCEDURE
Failed Attempt to Localize Ascitic Fluid
• Consequence
• Prevention
Another suggestion for difficult cases is to reposition the patient. Although paracentesis is traditionally performed with the patient lying semirecumbent, a hand-knee position may be used instead.7 If the patient is unable to maintain this position, he or she can be positioned prone between two beds with the physician performing the tap from the floor beneath.
Failure due to Inappropriate Needle Selection
• Consequence
• Prevention
Distorted Anatomy Leading to Perforation of Adjacent Organ
• Consequence
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