Paracentesis

Paracentesis is a medical procedure that involves the removal of fluid from the abdominal cavity, also known as the peritoneal cavity. This procedure is typically performed to diagnose and treat conditions such as ascites, which is an accumulation of excess fluid in the abdominal cavity.

Indications

The indications for paracentesis include:

• Diagnosis of ascites
• Treatment of tense or large-volume ascites
• Relief of discomfort or pain caused by ascites
• Diagnostic evaluation of peritoneal fluid for infection, cancer, or other conditions

Contraindications

The contraindications for paracentesis include:

• Pregnancy
• Intrauterine shunt or other intra-abdominal shunts
• Presence of an intrauterine device (IUD)
• Previous abdominal surgery with potential adhesions
• Coagulopathy or bleeding disorders

Procedure

The paracentesis procedure typically involves the following steps:

1. The patient is positioned in a comfortable position, usually sitting up with their back straight and legs dangling over the side of the bed.
2. The skin is cleaned and disinfected with an antiseptic solution.
3. A local anesthetic is injected into the skin to numb the area.
4. A needle or catheter is inserted into the abdominal cavity, usually in the lower abdomen, just below the umbilicus (belly button).
5. The fluid is aspirated from the abdominal cavity using a syringe or drainage bag.
6. The needle or catheter is removed and the skin is cleaned and dressed with a bandage.

Complications

The potential complications of paracentesis include:

• Bleeding or hemorrhage
• Infection
• Bowel perforation
• Bladder perforation
• Hypotension (low blood pressure)

Aftercare

After the procedure, the patient should:

• Rest for several hours to allow the puncture site to heal.
• Avoid heavy lifting or strenuous activities for 24-48 hours.
• Monitor the puncture site for signs of infection, such as redness, swelling, or drainage.
• Follow up with their healthcare provider to review the results of the procedure and discuss any further treatment or management.

Interpretation of Results

The fluid removed during paracentesis is sent to a laboratory for analysis. The results may include:

• Appearance: cloudy, clear, or bloody
• Cell count: white blood cell count, red blood cell count
• Culture: bacterial, fungal, or viral culture
• Cytology: examination of cells for cancer or other abnormalities
• Chemistry: measurement of protein, albumin, and other substances in the fluid.

Special Considerations

Paracentesis may be performed in conjunction with other procedures, such as:

• Ultrasound-guided paracentesis to help guide the needle into the correct location.
• Laparoscopy or laparotomy to visualize the abdominal cavity and perform additional procedures.