Paracentesis
Paracentesis | |
---|---|
ICD-10-PCS | Illustration depicting Paracentesis |
ICD-9-CM | 54.91 |
MeSH | D019152 |
Paracentesis (from
The procedure is used to remove fluid from the peritoneal cavity, particularly if this cannot be achieved with medication. The most common indication is ascites that has developed in people with cirrhosis.
Indications
It is used for a number of reasons:[3]
- to relieve abdominal pressure from ascites
- to diagnose spontaneous bacterial peritonitis and other infections (e.g. abdominal TB)
- to diagnose metastatic cancer
- to diagnose peritonealspace in trauma
Paracentesis for ascites
The procedure is often performed in a doctor's office or an outpatient clinic. In an expert's hands, it is usually very safe,[4] although there is a small risk of infection, excessive bleeding or perforating a loop of bowel. These last two risks can be minimized greatly with the use of ultrasound guidance.[4][5]
Ultrasound guidance
The use of
Procedure overview
The patient is requested to urinate before the procedure; alternately, a Foley catheter is used to empty the bladder. The patient is positioned in the bed with the head elevated at 45–60 degrees to allow fluid to accumulate in lower abdomen. After cleaning the side of the abdomen with an antiseptic solution, the physician numbs a small area of skin and inserts a large-bore needle with a plastic sheath 2 to 5 cm (1 to 2 in) in length to reach the peritoneal (ascitic) fluid. The needle is removed, leaving the plastic sheath to allow drainage of the fluid. The fluid is drained by gravity, a syringe, or by connection to a vacuum bottle. Several litres of fluid may be drained during the procedure; however, if more than two litres are to be drained, it will usually be done over the course of several treatments.[6] After the desired level of drainage is complete, the plastic sheath is removed and the puncture site bandaged.[6] The plastic sheath can be left in place with a flow control valve and protective dressing if further treatments are expected to be necessary.[6]
If fluid drainage in
The procedure generally is not painful and does not require sedation. The patient is usually discharged within several hours following post-procedure observation provided that blood pressure is otherwise normal and the patient experiences no dizziness.[1][9][10]
Complications
Paracentesis is known to be a safe procedure when ascitic fluid is readily visible, so complications are typically rare. Possible complications following or during the procedure involve infection, bleeding, the leakage ascitic of fluid, or
The z-tracking technique has held particular importance in performing paracentesis. A z-track is a technique that allows for decreased ascitic fluid leak following the paracentesis by displacing the needle tracks with respect to the epidermis and the peritoneum.[6]
Fluid analysis
The serum-ascites albumin gradient can help determine the cause of the ascites.[7]
The color of the ascitic fluid can also be useful in analysis. Blood fluid can indicate trauma or malignancy. A milky appearance of the fluid can indicate lymphoma or malignant peritoneal ascites. Cloudy or turbid fluid can indicate possible infection or inflammation within the peritoneal cavity. Straw or light yellow colored fluid indicates more plasma-like and benign causes of peritoneal ascites.[3]
The ascitic white blood cell count can help determine if the ascites is infected. A count of 250 neutrophils per ml or higher is considered diagnostic for spontaneous bacterial peritonitis. Cultures of the fluid can be taken, but the yield is approximately 40% (72–90% if blood culture bottles are used). Empiric antibiotics are typically started when spontaneous bacterial peritonitis is highly suspected. A third-generation cephalosporin is typically started in these cases to cover the most common organisms, E. coli and Klebsiella, in SBP. [7]
Contraindications
Mild hematologic abnormalities do not increase the risk of bleeding.[12][7] The risk of bleeding may be increased if:[13]
- prothrombin time > 21 seconds
- international normalized ratio> 1.6
- platelet count< 50,000 per cubic millimeter.
Absolute contraindication is the acute abdomen that requires surgery.
Relative contraindications are:[6]
- Pregnancy
- Distended urinary bladder
- Abdominal wall cellulitis
- Distended bowel
- Intra-abdominal adhesions.[1]
See also
References
- ^ a b c Paracentesis at eMedicine
- ^ Farlex dictionary > paracentesis, citing:
- Gale Encyclopedia of Medicine. Copyright 2008
- The American Heritage Medical Dictionary Copyright 2007
- McGraw-Hill Concise Dictionary of Modern Medicine. Copyright 2002
- ^ S2CID 5578130.
- ^ a b "Ascites". The Lecturio Medical Concept Library. Retrieved 1 July 2021.
- ^ S2CID 4735632.
- ^ PMID 28613769. Retrieved 1 July 2021.
- ^ PMID 16966752.
- ^ PMID 28004601.
- ^ "Treatments and Services | Gastroenterology and Hepatology | Dartmouth-Hitchcock". Archived from the original on 2012-04-23. Retrieved 2011-12-05.
- ^ "Paracentesis". Archived from the original on 2011-10-08. Retrieved 2011-12-05.[full citation needed]
- PMID 25580114.
- S2CID 12286809.
- S2CID 13452171.
External links
- WebMD: Patient guide