- Paracentesis
Interventions infobox
Name = Paracentesis
ICD10 =
ICD9 = 54.91
OtherCodes =
Paracentesis is a medical procedure involving needle drainage of fluid from a body cavity, most commonly the abdomen. It is used for a number of reasons:
* to relieve abdominal pressure fromascites
* to diagnosespontaneous bacterial peritonitis and other infections (e.g. abdominal TB)
* to diagnosemetastatic cancer
* to diagnoseblood inperitoneal space in trauma
* to puncture the tympanic membrane for diagnostic purposes, such as taking a bacterial swab from the middle ear.A related procedure is
thoracocentesis , which is needle drainage of the chest cavity.Paracentesis for Ascites
The procedure is often done in a doctor's office or an out-patient clinic. In an expert's hands, it is very safe, although there is a very small risk of introducing an infection, causing excessive bleeding or perforating a loop of bowel.
During the procedure, patients are asked to lie down and expose their abdomen. After cleaning the side of the abdomen with an antiseptic solution, physicians will numb a small area of skin and then insert a fairly large-bore needle (along with a plastic sheath) 2 to 5 cm to reach the peritoneal (ascitic) fluid. The needle is then removed, leaving the plastic sheath behind to allow drainage of the fluid. The fluid can be drained by gravity or by connection to a vacuum bottle. Up to 11
litre s of fluid may be drained during the procedure. If fluid drainage is more than 5 litres, patients may receiveintravenous serum albumin (25% albumin, 8g/L) to preventhypotension (low blood pressure).The procedure generally is not painful; patients require no
sedation . As long as they are not too dizzy and maintain their blood pressure after the procedure, they can go home afterwards.Ascitic fluid analysis
The
serum-ascities albumin gradient can help determine the cause of the ascites.The ascitic white blood cell count can help determine if the ascites is infected.Contraindications
Mild hematologic abnormalities do not increase the risk of bleeding.cite journal |author=McVay PA, Toy PT |title=Lack of increased bleeding after paracentesis and thoracentesis in patients with mild coagulation abnormalities |journal=Transfusion |volume=31 |issue=2 |pages=164–71 |year=1991 |pmid=1996485 |doi=10.1046/j.1537-2995.1991.31291142949.x] The risk of bleeding may be increased if:cite journal |author=Ginès P, Cárdenas A, Arroyo V, Rodés J |title=Management of cirrhosis and ascites |journal=N. Engl. J. Med. |volume=350 |issue=16 |pages=1646–54 |year=2004 |pmid=15084697 |doi=10.1056/NEJMra035021]
*prothrombin time > 21 seconds
*international normalized ratio > 1.6
*platelet count < 50,000 per cubic millimeter.References
External links
* [http://note3.blogspot.com/2004/02/paracentesis-procedure-guide.html Paracentesis - a step-by-step procedure guide] . Clinical Notes.
* WebMD: [http://my.webmd.com/hw/brain_nervous_system/hw198220.asp Patient guide]
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