Paracentesis

How should I prepare for paracentesis?

Your healthcare provider will explain the procedure and ensure you’re prepared. They’ll:

• Ensure you’re a good candidate for paracentesis. Your provider will review your medical history, including previous surgeries, allergies and your response to anesthesia. They’ll determine whether you’re pregnant. You can still get paracentesis during pregnancy. Your provider will take care to keep you and the fetus safe.
• Advise you on medicines and supplements to take. You may need to stop taking blood thinners, like aspirin or warfarin (Coumadin®), vitamins and supplements. You may need to change your medicines if you take nonsteroidal anti-inflammatory drugs (NSAIDs) or certain diabetes medications. Follow your provider’s instructions.
• Advise you on fasting. Before your procedure, you may need to stop drinking liquids or eating certain foods. Your provider will advise you on adjusting your eating and drinking so you’re prepared.

What happens during this procedure?

You can get paracentesis in your provider’s office or at a hospital. You may need to pee beforehand so your bladder is empty for the procedure.

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Once you’re ready, a healthcare provider will:

1. Position you. Chances are, you’ll be on your back. The bed may be completely flat, or it may be slightly raised to lift your head.
2. Clean and numb the area where the needle will go. You’ll get a small injection of medicine that prevents you from feeling any pain. You may feel a quick prick when the needle goes in.
3. Insert the needle and catheter. Your provider will insert the needle in the numbed area, above the ascites. Many providers use an ultrasound while inserting the needle. Ultrasounds show fluid buildup in your body (like ascites), so your provider knows exactly where the needle should go. They’ll place a plastic catheter tube into the site to help the fluid drain.
4. Drain the ascites. They may use a syringe or a vacuum-powered container to collect the fluid. They’re more likely to use a vacuum container with suction power if they’re draining several liters of fluid. This makes the process go faster.
5. Remove the needle and bandage the site. They’ll remove the needle and apply pressure to the site to stop bleeding. They’ll bandage the area.

If ascites frequently return after paracentesis, your provider may place a tube called a tunneled peritoneal drainage catheter into the drainage site. You’ll wear this tube long-term, so you won’t have to keep returning for paracentesis. Part of the tube goes inside your abdomen, and the other side goes outside. The outside part attaches to a bottle that continually collects fluid. You’ll drain the bottle at home.

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Your healthcare provider will advise you on whether this is a good option.

How long does paracentesis take?

Paracentesis takes from 20 to 45 minutes. Timing depends on how much fluid is removed.

How much fluid can paracentesis remove?

For diagnostic paracentesis, your healthcare provider will remove enough fluid to perform all the necessary tests. This is usually about 25 milliliters (ml).

For therapeutic paracentesis, the amount of fluid depends on how much excess fluid you have and whether you have a history of fluid returning. Often, removing 5 liters is enough to relieve abdominal pressure from ascites. Your provider may remove more fluid if your ascites often return (recur).

How painful is paracentesis?

You may feel a brief sting when the numbing needle goes in. You may also feel pressure or discomfort during the draining, but it shouldn’t feel painful.

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Still, let your provider know if you feel uncomfortable or light-headed during the procedure. This is more likely to happen if your provider removes large amounts of fluid. They can give you pain medicines that can help.

What happens after paracentesis?

Your care team will monitor your vital signs for about an hour afterward. While you’re recovering, you may notice small amounts of clear fluid seeping from the bandaged site, but don’t be alarmed. This is normal.

What tests are performed on the fluid sample?

If the procedure is diagnostic, your provider will send the fluid sample to a lab for peritoneal fluid analysis. The analysis includes a series of tests that may include any of the following:

• Complete blood count (CBC). This test checks your blood cells. High levels of white blood cells may signal inflammation or infection.
• Bacteria culture test. This test can show if the fluid in your abdomen is infected. It can help your provider identify the type of bacteria causing the infection so they know what type of antibiotics will get rid of it.
• This test can show cell abnormalities that may be signs of cancer.

Tests may also check your levels of:

• Albumin.
• Alkaline phosphatase.
• Amylase.
• Glucose.
• LDH.
• Protein.

Knowing these levels can help your healthcare provider determine if your ascites likely result from cancer, an infection, an injury to an organ (like your bowel), organ damage (like heart failure) or other common causes.

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