Paracentesis

Excerpt

Paracentesis is a fundamental procedure in evaluating and managing ascites, defined as the abnormal fluid accumulation within the peritoneal cavity. The procedure involves inserting a needle into the peritoneal space to remove ascitic fluid, which may be performed for diagnostic or therapeutic purposes. Diagnostic paracentesis is essential for determining ascites' etiology and ruling out infection, particularly spontaneous bacterial peritonitis (SBP). Therapeutic paracentesis allows for removing large volumes of fluid to alleviate the significant discomfort and respiratory compromise associated with tense ascites. Ascitic fluid analysis should be performed in all patients with new-onset ascites; timely intervention is critical. In fact, study results demonstrate that patients with suspected SBP who undergo delayed paracentesis face a 2.7-fold increased risk of mortality compared to those receiving early paracentesis within 12 hours of initial physician evaluation.

Cirrhosis of the liver is the most common underlying cause of ascites, and its presence significantly worsens prognosis. Patients with cirrhosis and ascites have an estimated 1-year mortality of 20%, compared to 7% in patients with cirrhosis but without ascites. Given these risks, paracentesis is a cornerstone of initial evaluation and a life-saving intervention in appropriate contexts. This review will address the indications, contraindications, and potential complications of paracentesis, while also emphasizing the role of an interprofessional care team in optimizing outcomes. Physicians, advanced practitioners, nurses, and other healthcare professionals are critical in ensuring early recognition, prompt diagnostic evaluation, and safe therapeutic fluid removal. In treating liver disease as a global health burden, proficiency in paracentesis and evidence-based care coordination are indispensable skills for healthcare professionals.