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An Evidence-Based Manual for Abdominal Paracentesis

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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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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  • DOI: https://doi.org/10.1007/s10620-007-9805-5

Keywords

  • Ascites
  • Paracentesis
  • Diagnosis
  • Review
  • Systematic review