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A paracentesis involves placing a needle or catheter (soft, flexible, rubber tube) into fluid in the abdominal cavity. Radiologists generally perform paracentesis using ultrasound guidance – we use an ultrasound machine to watch as the needle is placed. This helps us ensure that the needle is placed in the correct spot and allows us to avoid important structures like the bowel and other organs.
There are many reasons that fluid can accumulate in the abdominal cavity: liver failure, infection, tumors and numerous others. Significant amounts of fluid can cause abdominal pain, abdominal distention, difficulty eating, difficulty sleeping and difficulty breathing. Paracentesis allows us to remove fluid so that those symptoms can be relieved. The fluid can also be sent to the laboratory to be tested for signs of infection, tumor cells and other characteristics to help determine the cause of the fluid accumulation. Paracentesis is often performed as an outpatient procedure.
Many members of Clinical Radiologists perform paracenteses. We are experienced and highly skilled at these procedures, performing hundreds every year.
What preparation is needed for a paracentesis?
The morning of the procedure you will report to the hospital registration desk and then proceed to the radiology department. Have someone with you who will be able to drive you home.
If your procedure is in the morning, you should not eat or drink after midnight the night before the procedure. You may, however, take your medicines in the morning with a small amount of water. If your procedure is in the afternoon, you may have a light breakfast. If you are diabetic, check with the Radiology Department or your personal physician for additional instructions about diet and medications. If you are on blood thinners, check with your physician for instructions.
What happens during the procedure?
You will generally lie on your back for the procedure. An ultrasound technologist will perform a brief ultrasound examination of your abdomen to document and evaluate fluid within the abdominal cavity.
The radiologist will discuss the procedure and its risks prior to beginning the procedure. If you have any questions about the procedure, be sure to ask! Let the technologist or radiologist know if you have any family members you want to be present while the radiologist explains the procedure and answers any questions. Family members will not be able to watch the procedure.
The radiologist will clean your skin and numb the skin and abdominal wall. A needle will be placed through the numb area into the fluid. In most cases there will be a soft, flexible catheter on the outside of the needle. The radiologist slides the catheter off the needle and take the needle out; nothing sharp stays in the abdomen. After the fluid is removed, the catheter is taken out, the skin is cleaned and a band-aid is placed over the puncture site. You will be observed in the department for 15-20 minutes and then discharged if you are feeling well.
In some cases, when very large volumes of fluid are to be removed, a nurse will start an IV so that we may administer a medication called albumin. Albumin is a protein that is made by the human body; it can help patients tolerate having large volumes of fluid removed and may slow the re-accumulation of fluid to some extent.
Most patients tolerate the procedure very well. Complications from paracentesis are very rare. You may experience some light-headedness for a day or so after the procedure, especially when large volumes of fluid are removed. Be sure to rise slowly from sitting or lying positions. Move your feet and legs to stimulate blood flow before rising. If you do feel light-headed, lie down until the feeling passes and then slowly sit, then stand or walk, if necessary.
What about after the procedure?
You should generally take it easy for a few hours following the procedure. You may eat and drink after the procedure. If any bruising develops at the procedure site, place ice on the area. Call the Radiology Department and ask to speak to a nurse or radiologist if you have any questions after leaving the department. Notify us if fluid is leaking from the puncture site or if you have persistent light-headedness. You may be given additional discharge instructions by the radiologist or nurse.
Abdominal fluid often recurs after paracentesis. Many people have the procedure repeated periodically as fluid re-accumulates. If the fluid re-accumulates relatively slowly, your doctor can make appointments for repeat procedures as needed. If you have large amounts of fluid that re-accumulate quickly, your doctor may make a standing appointment to have the paracentesis repeated every week or two.
If the fluid is sent to be tested, the test results will be sent to your physician. Call your doctor’s office in two to three days for results unless other arrangements have been made.