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Paracentesis:
Since we have covered so many other procedures I though I would include paracentesis for completion.
A diagnostic paracentesis (typically 30-60 ml) is indicated to:
- Determine etiology of new ascites (transudate vs exudate, cancer, infection)
- Rule out spontaneous bacterial peritionitis...(suspect this in any patient with a history of ascites that has fever, mental status changes, or diffuse abdominal pain)
A therapeutic paracentesis (large volume >1L) is indicated in the emergency department for:
- Respiratory distress from abdominal distension
- Abdominal compartment syndrome. See Dr. Winters Pearl
Remember large volume paracentesis can result in profound fluid shifts and subsequent hypotension.
Absolute Contraindications to paracentesis include: Acute abdomen requiring surgery
Relative contraindications are:
- Platelets <20,000
- INR > 2
- Pregnancy
- h/o adhesions
- abdominal wall cellulitis (just don't stick the needle through the cellulitis)
- Distended bowel or bladder
To view a video on how to do a paracentesis please visit the New England Journal of Medicine http://content.nejm.org/cgi/content/short/355/19/e21
Next I will address how to interpret the paracentesis fluid results.