Paracentesis

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A paracentesis is a medical "procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument."^[1][2][3] A paracentesis usually refers to removing ascites.

Procedure

The location of the inferior epigastric artery within the sheath of the rectus muscle.

If a lower quadrant is used, inserting the needle lateral to the rectus muscle will avoid the inferior hypogastric artery.

Routine ultrasonography can increase success rates according to a randomized controlled trial.^[4]

If more than 5 liters of ascites are removed, consider giving 6.25 g of albumin for each liter over 5 liters.^[5]

Interpretation of results

Cell count

• Polymorphonuclear cells count of 250/mm³ or more suggests spontaneous bacterial peritonitis

Albumin

• A serum-ascites albumin gradient (SAAG) of less than 1.1 g/dL lowers the probability of portal hypertension.^[2]

Protein

• Protein levels less than 1 g/dL have a high risk of spontaneous bacterial peritonitis during hospitalizations.

Ph

• "An ascitic fluid pH of lower than 7.35 (likelihood ratio=9.0) and a blood–ascitic fluid pH gradient of 0.10 or greater (likelihood ratio=11.3) were the most accurate thresholds for diagnosing spontaneous bacterial peritonitis" according to a systematic review by the Rational Clinical Examination.^[2]

Cultures

References

1. ↑ Anonymous, (2009) Paracentesis (English). Medical Subject Headings. U.S. National Library of Medicine.
2. ↑ ^{2.0 2.1 2.2} Wong CL, Holroyd-Leduc J, Thorpe KE, Straus SE (March 2008). Does this patient have bacterial peritonitis or portal hypertension? How do I perform a paracentesis and analyze the results?. JAMA 299 (10): 1166–78. DOI:10.1001/jama.299.10.1166. PMID 18334692.
3. ↑ Thomsen TW, Shaffer RW, White B, Setnik GS (November 2006). Videos in clinical medicine. Paracentesis. N. Engl. J. Med. 355 (19): e21. DOI:10.1056/NEJMvcm062234. PMID 17093242.
4. ↑ Nazeer SR, Dewbre H, Miller AH (May 2005). Ultrasound-assisted paracentesis performed by emergency physicians vs the traditional technique: a prospective, randomized study. Am J Emerg Med 23 (3): 363–7. PMID 15915415.
5. ↑ Ginès P, Titó L, Arroyo V, et al (June 1988). "Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis". Gastroenterology 94 (6): 1493–502. PMID 3360270.