Paracentesis is a procedure performed both for diagnostic and treatment purposes. It involves removing fluid from the abdomen via a needle. Conditions such as cirrhosis of the liver, certain abdominal and pelvic malignancies and abdominal infections predispose one to fluid collections, or ascites, in the abdominal cavity. Without removal, this fluid can become infected or apply pressure causing structural damage to the intra-abdominal organs.
Abdominal Bleeding
Liver disease, one of the main causes of abdominal fluid build-up, can also cause susceptibility to clotting problems. After the needle is removed from the abdomen, bleeding may continue to occur from the vessels providing blood flow to the inner abdominal wall. Uncontrolled bleeding may cause hematoma formation evidenced by pain, visible bruising or a palpable mass in the abdomen.
Infection
Introducing a needle into a previously sterile space creates an opportunity for microbes to enter and multiply. The use of proper sterile technique, draping and autoclaved instruments have greatly minimized this risk. However, all procedures that involve puncture through the epidermis carry a risk of introducing skin bacteria into the wound.
Leakage
Relieving intra-abdominal pressure via paracentesis may not fully decompress the abdomen. As fluid pockets shift within the abdomen, it is prudent to drain the largest area in order to provide the most relief. Remaining ascites may leak out of the paracentesis site after the needle and catheter have been removed, particularly if abdominal pressure is increased during coughing and defecating. The puncture site can be sutured closed if leakage continues to be a problem.
Post-Procedural Hypotension
Rapid removal of ascetic fluid from the peritoneal space can cause rapid shifts in intravascular volume. This can result in a post-procedural drop in blood pressure. Commonly, it is prevented by replacing intravascular volume with albumin solution, which prevents movement of fluid out of the blood vessels.
References
- "Journal of the American Medical Association"; Does This Patient Have Bacterial Peritonitis or Portal Hypertension? How Do I Perform a Paracentesis and Analyze the Results?; Wong, C et al.; March 2008
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