What is it?
A paracentesis is a procedure in which excess fluid from the abdominal cavity (belly) is removed using a needle. It is not normal to have fluid in this cavity, so any amount of fluid can cause difficulty breathing, pain, and discomfort. The buildup of extra fluid in the abdomen is called ascites.
There are two reasons that a paracentesis may be performed. 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 has most likely already been confirmed.
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 his or her 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, an MRI or CT scan of your abdomen. These can all show a buildup of fluid.
Once your paracentesis is complete and the fluid has been tested (if needed), your provider will notify you of the follow-up plan and further treatment options. Speak with your provider about any concerns you may have.
How is it done?
A 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. Notify your provider of any medications you are taking, any bleeding disorders you have, any allergies, or if you may be pregnant. It is often recommended that you not eat or drink anything for 12 hours prior to the procedure and 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. The amount of discomfort should be minimal. You may be asked to put on a hospital gown. You may receive pain and/or anti-anxiety medication prior to the procedure, if needed.
- You will be asked to lie flat on your back or to remain sitting up. If you are unable to tolerate lying flat, you may have your head elevated 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 get to. 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 moments to ensure the area is properly numbed.
- Once the area is numb, your provider will insert a needle at the space previously marked. You may feel some pressure as the needle is inserted or you may feel a temporary sharp pain. If the pain does not subside, tell your provider. In some cases, a small incision 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, a test tube or large glass container. 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 complete 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 instructs you otherwise.
What are the risks?
Risks associated with a paracentesis include leaking of fluid from the needle insertion site, bleeding, hypotension (low blood pressure), puncture of a blood vessel, bowel or bladder, and infection. Leaking of clear fluid from the insertion site is normal and you may need to change the bandage a few times. Low blood pressure 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 regulate the blood pressure. Puncture of a blood vessel, bowel or bladder is uncommon but may lead to the need for surgical repair. If the area appears infected (redness, tender or sore, pus or smelly drainage or if you develop a fever), notify your provider. Infection can be treated with antibiotics.
When to contact your 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 contact 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 notify your provider if your abdomen increases in girth, your pain is uncontrolled 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.