Paracentesis

What is it?

A paracentesis is a procedure done to remove excess fluid from the abdominal (belly) cavity using a needle. It is not normal to have fluid in this cavity, so any amount of fluid can cause you to have pain, discomfort, and a hard time breathing. The buildup of fluid in the abdomen is called ascites.

There are two reasons that a paracentesis may be done. These are:

• Diagnostic: Paracentesis is used to test the fluid and find the cause of the ascites. Ascites can be caused by infection, inflammation, trauma, cirrhosis of the liver, and cancer.
• Therapeutic: Paracentesis is done to relieve the symptoms and discomfort caused by ascites. In this case, the cause of the ascites is known.

Ascites is diagnosed based on your medical history, your physical exam, and diagnostic testing. Symptoms can include shortness of breath, discomfort, pain, and early satiety (feeling of fullness soon after you start eating). Your provider will palpate (touch with their hands) your stomach and may measure your abdominal girth (measurement around your stomach), and weight. You may have an abdominal x-ray, an ultrasound of your stomach, and an MRI or CT scan of your abdomen. These can all show a buildup of fluid.

Once your paracentesis is done and the fluid has been tested (if needed), your provider will let you know about the follow-up plan and further treatment options. Speak with your provider about any questions or concerns you may have.

How is it done?

Paracentesis can be done either in a provider’s office or in the hospital. Your provider will explain the procedure and have you sign a consent form. Tell your provider about any medications you are taking, any bleeding disorders you have, allergies, or if you may be pregnant. It is often recommended that you not eat or drink anything for 12 hours before the procedure. You should use the bathroom before the start of the procedure.

A paracentesis takes about 10-30 minutes. You will be awake for the procedure. You should not have much discomfort or pain during the paracentesis. You may be asked to put on a hospital gown. You may receive pain and/or anti-anxiety medication before the procedure if needed.

• You will be asked to lie flat on your back or to remain sitting up. If you are unable to lie flat, you may have your head raised slightly. Once you are in a comfortable position, your provider will ask you to stay still.
• An ultrasound may be used to find the space where the fluid is easiest to reach. A cool or warm gel will be placed on the ultrasound probe, and you may feel slight pressure where the ultrasound is being used. This is not painful. Once your provider finds a good space to insert the needle, the spot will be marked.
• Next, the provider will clean the area where the needle will be inserted. This will most likely feel cold. A sterile drape may be placed around the area of the insertion site.
• The area where the needle will be placed is then numbed. A small needle will be used to inject the local anesthetic (numbing medication) below the skin. The medication may cause a brief burning or stinging feeling. Your provider will wait a few minutes to make sure the area is numb.
• Once the area is numb, your provider will insert a needle at the space that is marked. You may feel some pressure as the needle is inserted or you may feel a temporary sharp pain. If the pain does not go away, tell your provider. In some cases, a small incision (cut) may be made in the skin to insert the needle.
• The fluid will drain through the needle, or a tube connected to the needle, into a container or test tube. The needle or tube will stay in as long as it takes to drain the amount of fluid needed either for testing or to relieve symptoms.
• Once the fluid is drained, the needle will be removed, and a small bandage will be placed at the insertion site. If an incision was made, the incision will be closed with 1-2 sutures and then covered with a bandage.
• Once the procedure is done, your vital signs may be monitored, and your abdominal girth may be measured. If you have had no side effects from the paracentesis, you can return to normal activity unless your provider tells you otherwise.

What are the risks?

Risks of paracentesis include:

• Leaking of fluid from the needle insertion site: This is normal and you may need to change the bandage a few times.
• Bleeding.
• Hypotension (low blood pressure): This can be a result of a large volume of fluid being removed and is treated with intravenous (IV) fluids and sometimes a transfusion of blood products (red blood cells). The infusion of fluid will help keep your blood pressure where it should be.
• Puncture of a blood vessel, bowel, or bladder: This is uncommon but may lead to the need for surgical repair.
• Infection: If the area appears infected (redness, tender or sore, pus or smelly drainage or if you develop a fever), call your provider. Infection can be treated with antibiotics.

When should I call my care team?

It is normal for some clear fluid to drain from the needle insertion site, most often when a large amount of fluid was removed. You should call your care team if you have any signs of infection at the insertion site, including: fever, chills, redness, swelling, or leaking of foul smelling fluid. You should also call your provider if your abdomen increases in girth (feels more swollen or round), your pain does not get better with pain medication prescribed to you, or if you have chest pain, shortness of breath, blood in your urine, or uncontrolled bleeding from the insertion site.