Radiology Procedures: Paracentesis (Overview)

OVERVIEW

This page is dedicated to organizing information relevant a paracentesis. This is a procedure that is commonly conducted in the field of interventional radiology however it is also conducted by diagnostic radiologists, and even those outside of radiology (such as those in internal medicine).

A paracentesis is a procedure that is very routinely performed by all types of providers .
WHAT IS A PARACENTESIS?

A paracentesis is a procedure where fluid that is present in the peritoneal space is either sampled or drained. Generally speaking there are two major types of this procedure (that are sometimes not mutually exclusive):

  1. Diagnostic paracentesis: used to help identify features of peritoneal fluid (ascites) that can help diagnose patients with a specific disease process or condition
  2. Therapeutic paracentesis: patients with a large volume of ascites can feel symptomatic relief when this fluid is drained.
INITIAL PROCEDURAL EVALUATION
  • Indications For A Paracentesis: a paracentesis can have a variety of different indications (both for diagnostic and therapeutic benefit as discussed above)
  • Contraindications For A Paracentesis: while it may seem like a very simple procedure, there are some instances in which it is actively contraindicated and should not be performed.
  • Fielding The Consult For A Paracentesis: other teams that order a paracentesis may not speak directly with the interventional radiology team for every paracentesis request, however when you have the opportunity to speak to the other provider directly it can be a good opportunity to gather more information efficiently.
  • Completing a chart review (writing pre-procedure note/H & P)prior to beginning the procedure it is important to review some key components of the patient’s chart. This is also an opportunity to begin writing a pre-procedure note/history and physical note.
  • Reviewing prior imagingit can be helpful to understand what to look for on diagnostic imaging BEFORE performing the paracentesis.
PRE-PROCEDURAL PREPERATION
PROCEDURAL CONSIDERATIONS

Considerations Before The Start Of The Case:

Steps Of The Paracentesis Procedure:

Below are the general steps of the paracentesis listed in order.

Other Procedural Considerations

  • Common complications of a paracentesis 
POST-PROCEDURAL CONSIDERATIONS
  • What type of analysis to send the ascites fluid for?
  • When to give albumin and how much?
  • How to sign out the patient post procedure to the primary team
  • Dictating the procedure/writing the radiology reportafter completing a paracentesis the case will have to be documented in a radiology report. There are some pieces of information that are useful to document.

Diagnostic Utility Of Ascites Fluid:

REFERENCES

The following sources were utilized when creating the content on this page (as well as the linked pages above):

New England Journal Of Medicine, Videos In Clinical Medicine: Paracentesis

Society Of Interventional Radiology, Survival Guide Series: POCUS, THE ESSENTIALS OF BEDSIDE ULTRASOUND GUIDED PROCEDURES

Proceduralist.org: Paracentesis

Management of Anticoagulant and Antiplatelet Medications in Adults Undergoing Percutaneous Interventions

Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part I: Review of Anticoagulation Agents and Clinical Considerations

Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations