Paracentesis Periprocedural Care

Updated: Jun 29, 2017
  • Author: Gil Z Shlamovitz, MD, FACEP; Chief Editor: Vikram Kate, MBBS, MS, PhD, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS  more...
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Periprocedural Care

Patient Education and Consent

Explain the procedure, benefits, risks, complications, and alternative options to the patient or the patient's representative, and obtain signed informed consent.

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Equipment

The equipment required can be found in a disposable paracentesis/thoracocentesis kit (see the image below).

Paracentesis/thoracocentesis tray. Paracentesis/thoracocentesis tray.

Equipment includes the following:

  • Antiseptic swab sticks
  • Fenestrated drape
  • Lidocaine 1%, 5-mL ampule
  • Syringe, 10 mL
  • Injection needles, 22-gauge (two)
  • Injection needle, 25-gauge
  • Scalpel, No. 11 blade
  • Catheter, 8 French, over 18-gauge × 7.5-in. needle with three-way stopcock, self-sealing valve, and a 5-mL Luer-Lok syringe
  • Syringe, 60 mL
  • Introducer needle, 20-gauge
  • Tubing set with roller clamp
  • Drainage bag or vacuum container
  • Specimen vials or collection bottles (three)
  • Gauze, 4 × 4 in.
  • Adhesive dressing
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Patient Preparation

Anesthesia

Local anesthesia with injection of lidocaine is employed. (See Technique.) For more information, see Local Anesthetic Agents, Infiltrative Administration.

Positioning

Patients with severe ascites can be positioned supine. Patients with mild ascites may need to be positioned in the lateral decubitus position, with the skin entry site near the gurney. The lateral decubitus position is advantageous because air-filled loops of bowel tend to float in a distended abdominal cavity.

The two recommended areas of abdominal wall entry for paracentesis are as follows (see the image below):

  • 2 cm below the umbilicus in the midline (through the linea alba)
  • 5 cm superior and medial to the anterior superior iliac spines on either side
Paracentesis: standard sites. Paracentesis: standard sites.

The authors recommend the routine use of ultrasonography to verify the presence of a fluid pocket under the selected entry site in order to increase the rate of success (see image below). [17]

Ultrasonogram showing ascites. Ultrasonogram showing ascites.

The use of ultrasonography also helps the practitioner avoid a distended urinary bladder or small bowel adhesions below the selected entry point. To minimize complications, avoid areas of prominent veins (caput medusae), infected skin, or scar tissue.

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