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Paracentesis

paracentesis, paracentesis procedure
Paracentesis from Greek κεντάω, "to pierce" is a form of body fluid sampling procedure, generally referring to peritoneocentesis also called laparocentesis in which the peritoneal cavity is punctured by a needle to sample peritoneal fluid12

Contents

  • 1 Indications
  • 2 Paracentesis for ascites
  • 3 Ascitic fluid analysis
  • 4 Contraindications
  • 5 References
  • 6 External links

Indicationsedit

It is used for a number of reasons:

  • to relieve abdominal pressure from ascites
  • to diagnose spontaneous bacterial peritonitis and other infections eg abdominal TB
  • to diagnose metastatic cancer
  • to diagnose blood in peritoneal space in trauma

Paracentesis for ascitesedit

The procedure is often performed in a doctor's office or an outpatient clinic In an expert's hands it is usually very safe, 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

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 If fluid drainage is more than 5 litres, patients may receive intravenous serum albumin 25% albumin, 8g/L to prevent hypotension low blood pressure After the desired level of drainage is complete, the plastic sheath is removed and the puncture site bandaged The plastic sheath can be left in place with a flow control valve and protective dressing if further treatments are expected to be necessary

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 dizziness134

Ascitic fluid analysisedit

The serum-ascites albumin gradient can help determine the cause of the ascites The ascitic white blood cell count can help determine if the ascites is infected

Contraindicationsedit

Mild hematologic abnormalities do not increase the risk of bleeding56 The risk of bleeding may be increased if:7

  • prothrombin time > 21 seconds
  • international normalized ratio > 16
  • platelet count < 50,000 per cubic millimeter

Absolute contraindication is acute abdomen that requires surgery Relative contraindications are:

  • Pregnancy
  • Distended urinary bladder
  • Abdominal wall cellulitis
  • Distended bowel
  • Intra-abdominal adhesions1

Referencesedit

  1. ^ a b c Paracentesis at eMedicine
  2. ^ 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
  3. ^ http://patientsdartmouth-hitchcockorg/gi/paracentesishtmlfull citation needed
  4. ^ http://appsmedbuffaloedu/procedures/paracentesisaspp=15full citation needed
  5. ^ McVay, PA; Toy, PT 1991 "Lack of increased bleeding after paracentesis and thoracentesis in patients with mild coagulation abnormalities" Transfusion 31 2: 164–71 PMID 1996485 doi:101046/j1537-2995199131291142949x 
  6. ^ Moore, K P; Aithal, G P 2006 "Guidelines on the management of ascites in cirrhosis" Gut 55: vi1–12 PMC 1860002  PMID 16966752 doi:101136/gut2006099580 
  7. ^ Ginès, Pere; Cárdenas, Andrés; Arroyo, Vicente; Rodés, Juan 2004 "Management of Cirrhosis and Ascites" New England Journal of Medicine 350 16: 1646–54 PMID 15084697 doi:101056/NEJMra035021 

External linksedit

  • Paracentesis - a step-by-step procedure guide Clinical Notes
  • WebMD: Patient guide

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