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An Evidence-Based Manual for Abdominal Paracentesis

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Abstract

The purpose of this study was to provide evidence-based approaches to detect ascites, perform paracentesis, order tests, and interpret the results. A Medline search was performed to identify relevant articles. Of 731 identified articles, 50 articles were used. The most sensitive findings for ascites detection are ankle edema (93%), increased abdominal girth (87%), flank dullness (84%), and bulging flanks (81%). Paracentesis is safe, with bleeding rates and leakage of <1%. An ascitic fluid polymorphonuclear cell count ≥250 cells/mm3 is the most sensitive test (86%–100%) to diagnose spontaneous bacterial peritonitis. The serum-ascites albumin gradient is the most useful test in identifying portal hypertension-related ascites. Large-volume paracentesis is effective in the treatment of refractory ascites. We conclude that paracentesis is a safe and vital procedure in patients with new-onset ascites. Once detected, an algorithmic approach to ordering tests and their interpretation is useful to determine etiology and direct further management.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

    Angela McGibbon, Grant I. Chen, Kevork M. Peltekian & Sander Veldhuyzen van Zanten

  2. Queen Elizabeth II Health Sciences Center, Victoria General Hospital Site, Room 928, South Wing, Centennial Building, Halifax, Nova Scotia, B3H 2Y9, Canada

    Sander Veldhuyzen van Zanten

Authors
  1. Angela McGibbon
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  2. Grant I. Chen
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  3. Kevork M. Peltekian
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  4. Sander Veldhuyzen van Zanten
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Correspondence to Sander Veldhuyzen van Zanten.

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McGibbon, A., Chen, G.I., Peltekian, K.M. et al. An Evidence-Based Manual for Abdominal Paracentesis. Dig Dis Sci 52, 3307–3315 (2007). https://doi.org/10.1007/s10620-007-9805-5

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