What is a paracentesis?

An abdominal paracentesis, or “tap”, is a procedure in which a catheter is inserted into the abdominal cavity and ascites fluid is removed.  Ascites is the accumulation of fluid in the abdomen, usually due to severe liver scarring or cirrhosis. This fluid can be sent to the laboratory to determine the cause of the ascites or to see if there is an infection.  This information may help in determining prognosis and treatment.

Where is the procedure done?

At the University of Chicago, most outpatient paracentesis’ are done in the GI procedure unit located in DCAM (6H).  They are usually done on Monday, Wednesday and Thursday afternoons. The procedure is performed by the physician assistant in our liver section, Amanda DeVoss.

How do I prepare for the procedure?

Your doctor or nurse will tell you if there are any medications you should stop before this procedure.  Usually you are asked to continue all of your medications, especially water pills and diabetic medications.  You MAY eat before this procedure.

How is the procedure done?

The nurse will bring you back into the GI procedure suite.  She will take your vital signs (heart rate, blood pressure, temperature).  She will also ask you questions about your medical history and what medications you are currently taking.  Before the procedure, an ultrasound will be done on your abdomen to determine how much ascites fluid is in the abdomen and to determine the best location to do this procedure.  Once a location is determined, the area is cleaned with an antibacterial agent.  Your skin is then numbed with lidocaine all the way down to where the fluid has collected.  A tiny nick is made with a scalpel so that a needle and catheter may be inserted into the abdomen.  Once the needle and catheter are in the abdomen, the needle is removed and the catheter is left in to drain the fluid.  The catheter is attached to a suction canister to help remove the fluid more quickly.  Once an adequate amount of fluid is removed, the catheter will be removed and a bandage is put on.  Usually there is no need for stitches, as the area closes up fairly rapidly.

It is fairly typical that you will receive an IV and get an infusion of albumin during the procedure.  Albumin is a protein that helps the body stabilize your blood pressure after the procedure. It can also help in slowing down reaccumulation of the ascites.  The amount of albumin you received will be determined based on how much fluid is removed and your blood tests.

What are the complications?

1. Bleeding. You will have blood tests done within a month of having this procedure. These tests will help your doctor determine if you are at increased risk of bleeding.  If your tests are too abnormal, your doctor may discuss other options with you.
2. Pain.  You may experience some discomfort when your skin is numbed with lidocaine. This discomfort usually only lasts a few seconds, as the medication starts to work.  Once your skin is numb, there should not be any discomfort during or after the procedure.
3. Perforation.  There is a very small risk of puncturing an organ or your bowels.  An ultrasound of the abdomen will be done before the procedure to make sure you have enough ascites fluid to safely do the procedure.  If the ultrasound does not show an adequate amount of fluid, the procedure will most likely NOT be done.

What else can I expect?

It is very common for patients to have to have this procedure done more than once. You will most likely feel tired or “drained” after this procedure. You should plan to relax the rest of the day, as you may not have extra energy.