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Paracentesis.  The procedure to remove abnormal collection of fluid from the peritoneal cavity.

INDICATIONS:

  • Differential diagnosis of ascites
  • Intraabdominal pressure causing respiratory distress
  • Differential diagnosis of acute peritonitis

CONTRAINDICATIONS:

  • Acute abdomen requiring immediate surgery (absolute contraindication)
  • Coagulopathy (relative contraindication)
  • Thrombocytopenia (relative contraindication)
  • Severe bowel distension (use extra caution or open technique)
  • Previous abdominal surgery, especially pelvic surgery
  • Pregnancy (necessitates using open technique above umbilicus after first trimester)
  • Distended bladder that cannot be emptied with a Foley catheter
  • Obvious infection at intended site of insertion (cellulitis or abcess)

COMPLICATIONS:

  • Bladder perforation
  • Small or large bowel perforation
  • Stomach perforation
  • Lacerations of major vessels (mesenteric, iliac, aorta)
  • Laceration of catheter or guide wire and loss in peritoneal cavity (might require laparotomy to recover catheter)
  • Abdominal wall hematomas
  • Incisional hernias
  • Wound infection
  • Wound dehiscence
  • Inability to retrieve majority of instilled fluid

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