About Paracentesis as treatment for ascites
Paracentesis is a minimally invasive, image-guided procedure in which fluid from the abdomen is removed through a long thin needle.
The fluid, usually a clear pale yellow liquid called serous fluid, is removed from the abdominal cavity to relieve pressure and to analyze it.
What is ascites?
Liquid that accumulates in the abdomen (fluid buildup) is called ascites. Ascites can seep out of organs for various reasons related either to disease or fluid pressures that are changing.
Causes of ascites include:
- Other conditions, such as cirrhosis or cancer
Why is paracentesis done?
Paracentesis may be done to:
- Diagnose an infection in the peritoneal fluid
- Determine the cause of fluid buildup (ascites) in the abdomen
- Check for certain types of cancer (e.g. liver cancer)
- Check for damage after an injury to the abdomen
This procedure is also performed in order to drain significant fluid that is:
- Causing pain
- Difficulty breathing
- Affecting how organs, such as the kidneys or bowel, are functioning
Where is it performed?
The procedure can be performed in a doctor’s office, the X-ray department of a hospital, in the emergency room, at your bedside in the hospital or in the interventional radiology suite at the hospital. RIA Endovascular interventional radiologists perform paracentesis in the radiology suites in local hospitals. They use ultrasound to both access the fluid and avoid blood vessels, intestines, bladder and other organs.
How do you prepare for paracentesis?
Your interventional radiologist will want to know about:
- Your medications
- Allergies to medicines, including anesthetics
- Whether you have any bleeding problems or are taking blood thinners, such as aspirin, nonsteriodal anti-inflammatory drugs (NSAIDS), warfarin (Coumadin), or Xarelto.
- If you are or might be pregnant
- Other blood tests may be done to make sure you do not have any bleeding or clotting problems.
Before the procedure begins, you will be asked to empty your bladder. You may be weighed and the distance around your abdomen may be measured both before and after the procedure.
How is the procedure done?
After the procedure has been explained and you have had your questions answered, you will be asked to sign a consent form. Paracentesis itself takes about 20 to 30 minutes; it will take longer if a greater amount of fluid is taken out.
When a large amount of fluid is to be removed out during the procedure, the patient may be asked to lie on his back with the head raised. If less fluid will be removed, it may be possible to sit up during the procedure.
The site where the interventional radiologist inserts the needle will first be cleaned with a special soap and then draped to create a sterile area.
An anesthetic will be applied to numb the area. Once the site is numb, the interventional radiologist will gently and slowly direct the paracentesis needle using ultrasound guidance to the extra fluid.
If a large amount of fluid is present, the paracentesis needle may be hooked by a small tube to a vacuum bottle so that the fluid can be drained off. Generally, up to 4 liters (1 gal) of fluid is removed. When a greater amount of fluid requires draining, the patient is given intravenous (IV) fluids through an IV line in a vein in the arm; this is to prevent low blood pressure and shock.
After the fluid has been drained, the needle is removed. A bandage is placed over the site. Vital signs, such as pulse, blood pressure and temperature are monitored for about an hour. Generally, you can resume activities after the test unless your doctor advises you differently.
How do patients feel during the procedure?
Patients sometimes experience a brief, sharp sting when the numbing medicine is given. When the paracentesis needle is placed in the belly, patients sometimes feel a temporary sharp pain or pressure.
If a large amount of fluid is removed, a patient often experiences dizziness or lightheadedness. Patients should let the doctor know if they begin to feel poorly at the test proceeds.
After paracentesis, some clear fluid may continue to drain from the site. This happens especially when a larger amount of fluid is removed. This generally lessens within a day or two. Use a small gauze pad and bandage if needed.
Are there risks involved?
Most procedures have some risk.
- There is a very small chance that the needle may poke the bowel, bladder or blood vessel in the abdomen. This risk is lessened by using image guidance, but the risk still exists.
- If cancer cells exist in the peritoneal fluid, there is a small chance that those cells may be spread in the belly.
- When a large amount of fluid is removed, there is a small chance that the patient’s blood pressure could drop to a dangerously low level, leading to shock. In this case, IV fluids or medicines, or both, may be administered to help return blood pressure to normal.
- By removing the peritoneal fluid, there is a small chance that it may affect how the kidneys work. For this reason, some patients are given IV fluids during the paracentesis.
Contact us after the procedure if you have any of these symptoms:
- Severe belly pain
- More redness or tenderness in your abdomen
- A fever greater than 100°F
The doctor or the office will get back to you with results.