Digestive Diseases and Sciences

, Volume 52, Issue 12, pp 3307–3315 | Cite as

An Evidence-Based Manual for Abdominal Paracentesis

  • Angela McGibbon
  • Grant I. Chen
  • Kevork M. Peltekian
  • Sander Veldhuyzen van ZantenEmail author
Review Paper


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.


Ascites Paracentesis Diagnosis Review Systematic review 


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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Angela McGibbon
    • 1
  • Grant I. Chen
    • 1
  • Kevork M. Peltekian
    • 1
  • Sander Veldhuyzen van Zanten
    • 1
    • 2
    Email author
  1. 1.Division of Gastroenterology, Department of MedicineDalhousie UniversityHalifaxCanada
  2. 2.Queen Elizabeth II Health Sciences Center Victoria General Hospital SiteHalifaxCanada

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