Abdominal Paracentesis (Ascites Fluid Tap, Abdominal Tap)

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Definition

Abdominal paracentesis is a procedure in which a needle is used to remove a sample of fluid or to drain an abnormal accumulation of fluid.

Usually, there is very little fluid in the abdominal cavity. However, there are a number of conditions that can cause fluid to accumulate in the abdomen, a condition called ascites. When fluid accumulates, an abdominal paracentesis may be done.

Ascites

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Parts of the Body Involved

Abdomen, chest

Reasons for Procedure

To determine the reason for fluid accumulation in the abdomen, which may occur due to:

  • Internal bleeding after an injury (usually a liver or spleen injury)
  • Infection
  • Cancer
  • Liver disease (including cirrhosis of the liver )
  • Pancreatic disease
  • Peritoneal disease

This procedure may also be done when excessive fluid accumulation in the abdomen makes breathing difficult and/or causes pain. In these cases, fluid is withdrawn to make breathing easier and to relieve abdominal discomfort.

Risk Factors for Complications During the Procedure

  • Bleeding disorder
  • Malnutrition
  • Hernia in or on the abdomen
  • Excess scar tissue from previous surgeries or injuries
  • Pregnancy
  • Severe intestinal inflammation or distension
  • Bladder distension not decreased by emptying the bladder via a catheter
  • Enlarged spleen or liver
  • Distended bowel due to an obstruction
  • Infection in the area where the paracentesis instrument will be inserted
  • Severe, acute abdominal condition requiring immediate surgery

What to Expect

Prior to Procedure

Your doctor will likely do some or all of the following:

Physical examBlood tests to make sure your blood clots normallyX-rayCT scan a type of x-ray that uses a computer to make pictures of structures inside the body Ultrasound a test that uses sound waves to examine parts of the body MRI scan a test that uses magnetic waves to make pictures of structures inside of the abdomen If the procedure is scheduled (rather than done in an emergency): Do not eat or drink for twelve hours before the procedure.Empty your bladder just before the procedure.You may need to have the area of entry shaved. During ProcedureAnesthesia and IV fluids if needed (eg, if your blood pressure is low) AnesthesiaLocal Description of the ProcedureYou lay on your back, with head at a 45-90 elevation. Or if there is only a small amount of fluid in your abdomen, you will position yourself on your hands and knees. The area where the needle will be inserted is cleaned with iodine or a similar solution, and draped with sterile cloths. An injection of a local anesthetic will be administered to numb the area. The paracentesis needle is carefully inserted into the abdomen and fluid is withdrawn using a syringe.The amount of fluid removed depends on the reason for this procedure. For diagnosis, small amounts of fluid are removed. For patients having trouble breathing, anywhere from 1-4 liters of fluid may be removed. After the needle is removed, a small bandage is put over the area of insertion. In case of malignant ascites (ie, accumulation of abdominal fluid due to direct effects of cancer) and when the goal of therapy is patients comfort, a larger amount of fluid, even 4-6 liters, can be removed at one time. If possible, this should be done with administration of intravenous albumins to minimize the risk of complications.
After ProcedureLaboratory examination of the removed fluid will be done. How Long Will It Take?Abdominal paracentesis can take as little as 10-15 minutes, but more time is required if there is a great deal of fluid to remove. Will It Hurt?There will be some stinging or burning while the anesthesia is being injected, but once the area is numbed, you should not feel the actual paracentesis. Possible ComplicationsBleedingPersistent leakage of ascitic fluidLow blood pressurePeritonitisAccidental piercing of other structures in the abdomen, such as the intestine, liver, spleen, stomach, bladder, or blood vesselsIn some patients, the procedure must be done again; this can result in loss of body protein. Average Hospital StayNo hospital stay is needed, if the procedure is done for diagnosis. If you have a lot of fluid or are having trouble breathing, you may need to stay in the hospital. Postoperative CareYou'll stay in the recovery room for a few hours, so that your blood pressure and other vital signs can be monitored. OutcomeTake it relatively easy the day after your procedure, but you won't need to continue to restrict your activities based on having had an abdominal paracentesis. Be aware that abdominal fluid can recur until the condition causing it has been treated. Therefore, you may need to have the procedure again.
In some situations, usually in patients with terminal cancer, when abdominal fluid continues to accumulate, instead of performing the paracentesis repeatedly, a catheter is inserted through the abdominal wall and left inside to drain accumulated fluid without repetitive needle insertions. Call Your Doctor If Any of the Following OccursSigns of infection, including fever and chillsRedness, swelling, increasing pain, excessive bleeding, or discharge from the paracentesis siteSwelling of the abdomenFeeling faint or lightheaded RESOURCES: Baylor College of Medicine, Department of Surgeryhttp://www.debakeydepartmentofsurgery.org MedlinePlus, National Library of Medicinehttp://medlineplus.gov CANADIAN RESOURCES: Canadian Medical Associationhttp://www.cma.ca/index.cfm/ci_id/37495/la_id/1.htm References: Aslam N, Marino CR. Malignant ascites: new concepts in pathophysiology, diagnosis, and management. Arch Intern Med . 2001;161:2733-7. Beers MH, Berkow R, et al. The Merck Manual of Diagnosis and Therapy , 17th ed. Merck & Co.; 1999. Braunwald E, Fauci AS, et al. Harrison's Principles of Internal Medicine , 15th ed. New York, NY: McGraw-Hill Professional; 2001.
Covey AM. Management of malignant pleural effusions and ascites. The Journal of Supportive Oncology . 2005;3:169-73. Smith EM, Jayson GC. The current and future management of malignant ascites. Clin Oncol . 2003;15:59-72. Townsend C, Beauchamp DR, et al. Sabiston Textbook of Surgery , 16th ed. Philadelphia, PA: WB Saunders; 2001. Last reviewed October 2007 by Marcin Chwistek, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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