Paracentesis: Difference between revisions

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A '''paracentesis''' is a medical "procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument."<ref>{{MeSH}}</ref><ref name="pmid18334692">{{cite journal |author=Wong CL, Holroyd-Leduc J, Thorpe KE, Straus SE |title=Does this patient have bacterial peritonitis or portal hypertension? How do I perform a paracentesis and analyze the results? |journal=JAMA |volume=299 |issue=10 |pages=1166–78 |year=2008 |month=March |pmid=18334692 |doi=10.1001/jama.299.10.1166 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=18334692 |issn=}}</ref><ref name="pmid17093242">{{cite journal |author=Thomsen TW, Shaffer RW, White B, Setnik GS |title=Videos in clinical medicine. Paracentesis |journal=N. Engl. J. Med. |volume=355 |issue=19 |pages=e21 |year=2006 |month=November |pmid=17093242 |doi=10.1056/NEJMvcm062234 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=17093242 |issn=}}</ref> A paracentesis usually refers to removing [[ascites]].
A '''paracentesis''' is a medical "procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument."<ref>{{MeSH}}</ref><ref name="pmid18334692">{{cite journal |author=Wong CL, Holroyd-Leduc J, Thorpe KE, Straus SE |title=Does this patient have bacterial [[peritonitis]] or [[portal hypertension]]? How do I perform a paracentesis and analyze the results? |journal=JAMA |volume=299 |issue=10 |pages=1166–78 |year=2008 |month=March |pmid=18334692 |doi=10.1001/jama.299.10.1166 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=18334692 |issn=}}</ref><ref name="pmid17093242">{{cite journal |author=Thomsen TW, Shaffer RW, White B, Setnik GS |title=Videos in clinical medicine. Paracentesis |journal=N. Engl. J. Med. |volume=355 |issue=19 |pages=e21 |year=2006 |month=November |pmid=17093242 |doi=10.1056/NEJMvcm062234 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=17093242 |issn=}}</ref> A paracentesis usually refers to removing [[ascites]].


==Procedure==
==Procedure==
{{Image|Gray-image522.gif|right|350px|The location of the inferior epigastric artery within the sheath of the rectus muscle.}}
{{Image|Gray-image522.gif|right|350px|The location of the inferior epigastric artery within the sheath of the rectus muscle.}}
Some experts recommend a over-the-needle catheter system.<ref name="pmid17093242">{{cite journal |author=Thomsen TW, Shaffer RW, White B, Setnik GS |title=Videos in clinical medicine. Paracentesis |journal=N. Engl. J. Med. |volume=355 |issue=19 |pages=e21 |year=2006 |month=November |pmid=17093242 |doi=10.1056/NEJMvcm062234 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=17093242 |issn=}}</ref>
Some experts recommend a over-the-needle catheter system.<ref name="pmid17093242">{{cite journal |author=Thomsen TW, Shaffer RW, White B, Setnik GS |title=Videos in clinical medicine. Paracentesis |journal=N. Engl. J. Med. |volume=355 |issue=19 |pages=e21 |year=2006 |month=November |pmid=17093242 |doi=10.1056/NEJMvcm062234 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=17093242 |issn=}}</ref>  


If a lower quadrant is used, inserting the needle lateral to the rectus muscle will avoid the inferior hypogastric artery.
If a lower quadrant is used, inserting the needle lateral to the [[rectus muscle]] will avoid the [[inferior hypogastric artery]].


Routine [[ultrasonography]] can increase success rates according to a [[randomized controlled trial]].<ref name="pmid15915415">{{cite journal |author=Nazeer SR, Dewbre H, Miller AH |title=Ultrasound-assisted paracentesis performed by emergency physicians vs the traditional technique: a prospective, randomized study |journal=Am J Emerg Med |volume=23 |issue=3 |pages=363–7 |year=2005 |month=May |pmid=15915415 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735675704003614 |issn=}}</ref>
Routine [[ultrasonography]] can increase success rates according to a [[randomized controlled trial]].<ref name="pmid15915415">{{cite journal |author=Nazeer SR, Dewbre H, Miller AH |title=Ultrasound-assisted paracentesis performed by emergency physicians vs the traditional technique: a prospective, randomized study |journal=Am J Emerg Med |volume=23 |issue=3 |pages=363–7 |year=2005 |month=May |pmid=15915415 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735675704003614 |issn=}}</ref>

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A paracentesis is a medical "procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument."[1][2][3] A paracentesis usually refers to removing ascites.

Procedure

The location of the inferior epigastric artery within the sheath of the rectus muscle.

Some experts recommend a over-the-needle catheter system.[3]

If a lower quadrant is used, inserting the needle lateral to the rectus muscle will avoid the inferior hypogastric artery.

Routine ultrasonography can increase success rates according to a randomized controlled trial.[4]

If more than 5 liters of ascites are removed, consider giving 6.25 g of albumin for each liter over 5 liters.[5]

Interpretation of results

Cell count

Albumin

  • A serum-ascites albumin gradient (SAAG) of less than 1.1 g/dL lowers the probability of portal hypertension.[2]

Protein

Ph

Cultures

References

  1. Anonymous (2024), Paracentesis (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. 2.0 2.1 2.2 Wong CL, Holroyd-Leduc J, Thorpe KE, Straus SE (March 2008). "Does this patient have bacterial peritonitis or portal hypertension? How do I perform a paracentesis and analyze the results?". JAMA 299 (10): 1166–78. DOI:10.1001/jama.299.10.1166. PMID 18334692. Research Blogging. Cite error: Invalid <ref> tag; name "pmid18334692" defined multiple times with different content
  3. 3.0 3.1 Thomsen TW, Shaffer RW, White B, Setnik GS (November 2006). "Videos in clinical medicine. Paracentesis". N. Engl. J. Med. 355 (19): e21. DOI:10.1056/NEJMvcm062234. PMID 17093242. Research Blogging.
  4. Nazeer SR, Dewbre H, Miller AH (May 2005). "Ultrasound-assisted paracentesis performed by emergency physicians vs the traditional technique: a prospective, randomized study". Am J Emerg Med 23 (3): 363–7. PMID 15915415[e]
  5. Ginès P, Titó L, Arroyo V, et al (June 1988). "Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis". Gastroenterology 94 (6): 1493–502. PMID 3360270[e]