Paracentesis

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Ascites:

Accumulation of abnormal amount of fluid in the abdominal cavity is defined as ascites.  

The most common cause for ascites is cirrhosis of the liver. Other conditions such as heart failure, kidney failure, infection or cancer can also cause ascites.

Symptoms:

  • Swelling in the abdomen
  • Weight gain
  • Bloating
  • Nausea/indigestion
  • Shortness of breath, etc.

Diagnosis:

Based on physical exam, ultrasound, or CT scan.

 

Management:

Although a small quantity of ascites fluid in the abdomen can be treated with a low salt diet and water pills, larger amounts of ascites can result in additional issues for patients.

When ascites becomes problematic, a paracentesis is recommended.

Removing the fluid helps to alleviate the symptoms.

The fluid can also be examined to discover the cause of the ascites which could be due to infection, cancer, or other medical problems.

Some people require frequent paracentesis to relieve the symptoms as fluid continues to reaccumulate.

If paracentesis requirements become to frequent, a radiological intervention like TIPS (Transjugular intrahepatic shunt creation) or surgical procedure like liver transplant may be recommended.

Patients in whom the symptoms are severe, requiring paracentesis almost every other day, may require a tunneled drainage catheter. This is often performed as a palliative measure in patients with an underlying cancer as the cause of severe, recurrent ascites.

Procedure:

Paracentesis (also referred to as an abdominal tap) is a procedure that employs a needle or catheter to drain fluid from the abdominal cavity.

A paracentesis is done in an outpatient clinic or in a hospital. Depending on the amount of fluid that needs to be drained, this procedure can take up to 30 minutes. The procedure can be performed with the patient lying on their back or at an incline.

The procedure is performed mostly along the right or left lower abdominal quadrant where the access is straight forward. A local anesthetic will be injected to numb the area where the physician will insert the needle or catheter through the skin and muscles into the abdominal cavity. Though this can be done blindly, ultrasound guidance can allow for real-time visualization of intra-abdominal contents and needle placement. The needle or catheter position is confirmed under ultrasound or by aspirating fluid. The catheter is connected to suction bottle to drain the fluid.

Depending on the underlying cause for the ascites and patients tolerance, only certain amount of fluid is drained as there is risk of rapid reaccumulation and hemodynamic instability. Often albumin may be given through an IV to counteract this issues of a larger amount of fluid is to be drained. Once the drainage is completed, the needle/catheter will be removed and a small bandage will be utilized to cover the area of insertion.

If the physician believes that fluid will build up again in a shorter period of time and there are no definitive management plans available may recommend a permanent tube which is called tunneled peritoneal drainage catheter (Pleurex) to be placed. One end of the catheter stays inside the body and the other end is tunneled and brought outside the body. There is no need for hospital visits and the patient can remove the fluid at home at their own convenience.

Complications:

Although paracentesis usually does not entail several complications, some may include discomfort/pain where the needle or catheter is inserted, infection, and inadvertent puncture of the bowel, bladder, or blood vessels when the needle is inserted, which has to be managed accordingly, for example a severe bleed may require an angiogram and embolization (rare).

What is Ascites?

Accumulation of excess body fluid in the abdominal cavity is called ascites

What causes ascites?

Ascites occurs by many different mechanisms, some of the causes include cirrhosis (scarring of the liver), heart or kidney failure, cancer, or infection.

What is Paracentesis?

Removal of excess fluid from the abdominal cavity is called paracentesis.

Why do I need paracentesis?

When ascites becomes symptomatic for the patient and is not controllable by diet and medications, a paracentesis is recommended. Removing the fluid helps relieve these symptoms, and also allows the fluid to be examined to discover the cause of the ascites which could be due to infection, cancer, or other medical problems.

How long does this procedure take?

Depending on the amount of fluid that needs to be drained, this procedure can take up to 30 minutes.

How is the procedure performed?

The procedure can be performed with the patient lying on their back or at and incline.

The procedure is performed mostly along the right or left lower abdominal quadrant where the access is straight forward. A local anesthetic will be injected to numb the area where the physician will insert the needle or catheter through the skin and muscles into the abdominal cavity. The needle or catheter position is confirmed under ultrasound or by aspirating fluid. The catheter is connected to suction bottle to drain the fluid.

What occurs after paracentesis?

Post paracentesis, the catheter or needle is removed. A small gauze pad and bandage may be necessary to protect the drainage site.

Who performs this procedure?

Many physicians are trained to perform simple Paracentesis. In some the access might be difficult due to technical issues or bleeding risks in which case interventional radiologist are requested to perform the procedure under image guidance.

What are the benefits of this procedure?

Typically a safe, minimally invasive procedure with no surgical incision. Drainage of fluid allows rapid relief of the symptoms.

What are the risks associated with this procedure?

Certain risks include, pain or discomfort at the insertion site, bleeding at the site, blood vessel injury, organ puncture, internal bleeding, or infection.

How can these risks be addressed?

Bleeding may be resolved with compression and in rare cases may require angiogram and embolization; infections can be treated with intravenous antibiotics.