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Diagnostic and therapeutic abdominal paracentesis


Abdominal paracentesis is a simple bedside or clinic procedure in which a needle is inserted into the peritoneal cavity and ascitic fluid is removed [1]. Diagnostic paracentesis refers to the removal of a small quantity of fluid for testing. Therapeutic paracentesis refers to the removal of 5 liters or more of fluid to reduce intra-abdominal pressure and relieve the associated dyspnea, abdominal pain, and early satiety [2].

This topic will review the performance of abdominal paracentesis. Ascitic fluid analysis and the differential diagnosis of ascites are discussed elsewhere. (See "Evaluation of adults with ascites" and "Spontaneous bacterial peritonitis in adults: Diagnosis".)


Paracentesis can be performed safely by any clinician who has received proper training. Some hospitals have a dedicated procedure team that performs simple procedures such as paracentesis and central line insertion. These teams, which typically include an experienced clinician or mid-level provider and an assistant, often use an ultrasound machine to guide the procedure. The availability of adequately trained staff is imperative to prevent delays. (See 'When to perform paracentesis' below.)


Indications — There are several generally accepted indications for abdominal paracentesis (table 1):

Evaluation of new onset ascites


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Literature review current through: Mar 2014. | This topic last updated: Feb 18, 2014.
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  2. Runyon BA, AASLD Practice Guidelines Committee. Management of adult patients with ascites due to cirrhosis: an update. Hepatology 2009; 49:2087.
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