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Concept
Paracentesis
Summary
Paracentesis (from Greek κεντάω, "to pierce") is a form of body fluid sampling procedure, generally referring to peritoneocentesis (also called laparocentesis or abdominal paracentesis) in which the peritoneal cavity is punctured by a needle to sample peritoneal fluid.
The procedure is used to remove fluid from the peritoneal cavity, particularly if this cannot be achieved with medication. The most common indication is ascites that has developed in people with cirrhosis.
It is used for a number of reasons:
to relieve abdominal pressure from ascites
to diagnose spontaneous bacterial peritonitis and other infections (e.g. abdominal TB)
to diagnose metastatic cancer
to diagnose blood in peritoneal space in trauma
The procedure is often performed in a doctor's office or an outpatient clinic. In an expert's hands, it is usually very safe, although there is a small risk of infection, excessive bleeding or perforating a loop of bowel. These last two risks can be minimized greatly with the use of ultrasound guidance.
The use of ultrasound has become the standard of care when preparing a patient for paracentesis. Confirmation of an ascitic effusion reduces the risks associated with a dry or blind tap of the abdomen. Anatomic landmarks, such as the midline linea alba approach, were traditionally used as reference points for needle insertion. Phased array or curvilinear ultrasound transducers are typically used in the hospital and outpatient setting to identify ascites in the abdominal cavity. Fluid within the abdominal cavity appears hypoechoic or anechoic (black) on ultrasound. Morison's pouch (hepatorenal recess) is a common starting location in concordance with ultrasound FAST (focused assessment with sonography for trauma) exam. Fluid collection can occur in a number of different locations and may be difficult to find, especially if the patient only exhibits a small volume of ascites. Measurement of the amount of fluid within the abdominal cavity is not necessary or very successful.
Official source
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