Paracentesis is a medical procedure used to obtain ascitic fluid from the peritoneal cavity for diagnostic or therapeutic purposes, with specific indications for diagnostic taps including new-onset ascites and suspected bacterial peritonitis. The procedure involves several steps, including consent, preparation, and fluid collection, along with sending samples for various laboratory tests to differentiate between types of ascites. Complications may arise, such as fluid leakage, hypotension, and infections, with causes for transudative and exudative ascites outlined.

1. By
Dr. Elfatih Mirghani
MBBS - MD

2. Definition:
Paracentesis is a procedure in which a needle or
catheter is inserted into the peritoneal cavity to
obtain ascitic fluid for diagnostic or therapeutic
purposes.

3. Diagnostic tap: is used for the following:
• New-onset ascites - Fluid evaluation helps to
determine etiology, differentiate transudate versus
exudate, detect the presence of cancerous cells.
• Suspected spontaneous or secondary bacterial
peritonitis: An ascitic fluid neutrophil count of than
500 cells/µL.
Therapeutic tap is used for the following:
• Respiratory compromise secondary to ascites
• Abdominal pain or pressure secondary to ascites
(including abdominal compartment syndrome)

4. Contraindications:
1. An acute abdomen that requires surgery (absolute)
2. Severe thrombocytopenia (platelet count <20 ×
103/μL) and coagulopathy (INR >2.0) relative.
3. Hepatic pre-coma.
4. Pregnancy.
5. Distended urinary bladder
6. Abdominal wall cellulitis.
7. Gaseous bowel distension

5. Steps of the procedure
1. Explain the procedure to the pt (benefits, risks,
complications)
2. Take a written consent from the pt.
3. Be sure the equipments are ready (antiseptic, gauze,
Sterile gloves & towel, 10 - 20 ml syringe with 20
gauge needle for diagnostic tab and IV set for
therapeutic tab, local Anasthesia, containers) (Show)
4. Position the pt (Supine with head elevated)
5. Determine the area of the puncture (Show)
6. Proper antiseptic preparations (Iodine) & cover with
towel (Show)
7. Infiltration of the area with local anesthesia (Show).

6. 8- make small incision in the skin (Show)
9- Introduce the trocar & canula using zig zag
movement during introduction to avoid leakage of
the ascitic fluid after removal of the needle till
obtaining ascitic fluid then remove the trocar
(Show).
10- Withdraw the amount needed for diagnostic
sample or connect the IV set to the needle incase of
therapeutic tab till removal of the required amount
(Show).
11- Remove the needle (Show).
12- Apply adhesive plaster.

7. Depending on the clinical situation, fluid may be sent
for the following laboratory tests:
1. Gram stain: for the detection of spontaneous bacterial
peritonitis.
2. Cell count (elevated counts may suggest infection) >
500 cell/µL
3. Bacterial culture.
4. Total protein level: differentiate between transudate &
exudate ascites:
 Exudate: protein content > 3g/dl, high in lactae
dehydrogenase , have a low PH ), low glucose level.
 Transudate: low protein (<3g/dl), low LDH, high pH,
normal glucose.

8. 5. Triglyceride levels (elevated in chylous ascites) in
which there is high ascitic fluid fat content
(triglyceride), usually > 110 mg/dL, (milky colored)
6. Bilirubin level (may be elevated in bowel
perforation).
7. Glucose level.
8. Amylase level (elevation suggests pancreatic
source)
9. Lactate dehydrogenase (LDH) level
10. Cytology.

9. Complications
1) Leakage of the Ascitic fluid.
2) Post paracentesis hypotension.
3) Infections: peritonitis.
4) Bleeding.
5) Precipitation of encephalopathy.
6) Trauma to abd organs bladder and bowl

10. • Causes of transudative ascites include the following:
• Hepatic cirrhosis
• Heart failure
• Fulminant hepatic failure
• Portal vein thrombosis.
• Nephrotic syndrome
• Causes of exudative ascites include the following:
• Peritoneal carcinomatosis
• Inflammation of the pancreas or biliary system
• Peritonitis
• Ischemic or obstructed bowel