Paracentesis is a procedure in which a needle or catheter is inserted into the peritoneal cavity to obtain ascitic fluid for diagnostic or therapeutic purposes.

Ascitic fluid may be used to help determine the etiology of ascites, as well as to evaluate for infection or presence of cancer. With regard to differentiation of transudate from exudate, the preferred means for characterizing ascites is the serum-ascitic albumin gradient (SAAG).

Diagnostic tap is used for the following:

New-onset ascites - Fluid evaluation helps to determine ethology, differentiate transudate versus exudate, detect the presence of cancerous cells, or address other considerations
Suspected spontaneous or secondary bacterial peritonitis Refractory ascites

Therapeutic tap is used for the following:

Respiratory compromise secondary to ascites. Abdominal pain or pressure secondary to ascites (including abdominal compartment syndrome)
Non-hypertriglyceridemia-induced severe acute pancreatitis with triglyceride elevation and pancreatitis-associated ascitic fluid.

Large-volume paracentesis is often required in patients with refractory ascites.

Definitive management for abdominal compartment syndrome (ACS) usually consists of performing emergency surgical decompression by means of a laparotomy.

It is well known that liver cirrhosis, when advanced, can cause moderate-to-severe ascites leading to impairment in the respiratory pattern.


An acute abdomen that requires surgery is an absolute contraindication.
Severe thrombocytopenia (platelet count < 20 × 103/μL) and coagulopathy (international normalized ratio [INR] >2.0) are relative contraindications.

Patients with an INR greater than 2.0 should receive fresh frozen plasma (FFP) prior to the procedure. One strategy is to infuse one unit of fresh frozen plasma before the procedure and then perform the procedure while the second unit is infusing.

Patients with a platelet count lower than 20 × 103/μL should receive an infusion of platelets before the procedure.

In patients without clinical evidence of active bleeding, routine laboratory tests such as prothrombin time (PT), activated partial thromboplastin time (aPTT), and platelet counts may not be needed before the procedure. In these patients, pretreatment with FFP, platelets, or both before paracentesis is also probably not needed.

Patient Education and Consent. Explain the procedure, benefits, risks, complications, and alternative options to the patient or the patient's representative, and obtain signed informed consent.

  • Anesthesia: Local anesthesia with injection of lidocaine is employed.
  • Positioning: Patients with severe ascites can be positioned supine. Patients with mild ascites may need to be positioned in the lateral decubitus position, with the skin entry site near the gurney. The lateral decubitus position is advantageous because air-filled loops of bowel tend to float in a distended abdominal cavity.
  • After proper antiseptic preparation and local anaesthesia, a diagnostic tap can be performed with a 10- to 20-mL syringe and an 18-gauge needle.
  • After proper antiseptic preparation and local anaesthesia, a therapeutic tap can be performed with an intravenous (IV) catheter over the needle connected to drainage tubing.
  • In patients who are afebrile, alert, and have no other signs of bacterial peritonitis, ascitic fluid labs are often not necessary to rule out SBP.
  • To minimize the risk of persistent leak from the puncture site, use a small-gauge needle or take a "Z" track during insertion of the needle. (During removal of the needle, the subcutaneous tissue seals on itself.)

Complications from paracentesis may include the following:

  • Failed attempt to collect peritoneal fluid
  • Persistent leak from the puncture site
  • Wound infection
  • Abdominal wall hematoma
  • Spontaneous hemoperitoneum - This rare complication is due to mesenteric variceal bleeding after removal of a large amount of ascitic fluid (>4 L).
  • Perforation of hollow viscus (small or large bowel, stomach, bladder)
  • Catheter laceration and loss in abdominal cavity
  • Laceration of major blood vessel (aorta, mesenteric artery, iliac artery)
  • Postparacentesis hypotension
  • Dilutional hyponatremia cases with a persistent leak, a single skin suture might solve the problem. The application of an ostomy bag around the puncture site keeps the leak contained until it is eventually sealed off.

Consult with our experienced Doctors

JNU is home to some of the most eminent doctors in the world, most of whom are pioneers in their respective arenas and are renowned for developing innovative and revolutionary procedures