Paracentesis Flashcards
Paracentesis indications
patients presenting with new-onset ascites of uncertain causation
Diagnostic when bacterial peritonitis is suspected in patients who receive regular paracentesis
To alleviate discomfort or respiratory compromise in patients with tense ascites who are hemodynamically stable
Paracentesis contraindications
patients with DIC
caution in pregnant patients or those with organomegaly, bowel obstruction, intraabdominal adhesions or a distended urinary bladder
The catheter should not pass through sites of cutaneous infection, visibly engorged vessels, surgical scars or abdominal hematoma
The left lateral approach is beneficial in obese patients because
the abdominal wall is thinner
the midline approach is beneficial because
it is devoid of blood vessels
analysis of ascites fluid
total protein lactate dehydrogenase glucose carcinoembryonic antigen alkaline phosphatase amylase triglyceride cytology mycobacterial culture
paracentesis complications
circulatory dysfunction may occur after large-volume paracentesis and is associated with hypotension, hyponatremia, and increased plasma catecholamine and renin levels
many experts recommend the use of albumin after more than 5 liters of ascitic fluid removed
dose of albumin
6-8 g per liter of fluid removed, administered intravenously after the completion of the procedure
other paracentesis complications
persistent leakage of ascitic fluid, localized infection, abdominal wall hematoma
hemorrhage, injury to intraabdominal organs and puncture of the inferior epigastric artery
Serum-Ascites Albumin gradient
Calculated by subtracting the albumin level in ascitic fluid from the serum albumin level obtained concurrently
Values 1.1 g/dL or greater indicate portal hypertension as the cause
Values less than 1.1 g/dL are indicative of other causes
