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Who Needs a Paracentesis? How Do I Optimize Safety? How Do I Interpret the Results?

  • Thomas YeichEmail author
Chapter

Abstract

Emergent diagnostic paracentesis is primarily performed to rule out infection. Emergency care providers should have a low threshold to perform diagnostic paracentesis on patients with ascites presenting with altered mental status, signs of infection, clinical deterioration, or other needs for hospitalization. Paracentesis is generally considered safe in the emergency setting. Use of ultrasound guidance, standard paracentesis kits, and entering at a 45° angle via either the infraumbilical or left lower quadrant approaches may optimize safety and yield. Inoculating culture bottles at the bedside improves sensitivity. With the exception of DIC, coagulopathy is not considered a contraindication to paracentesis. Parenteral albumin infusion is recommended to prevent paracentesis-induced circulatory dysfunction when ascitic volumes over 5 L are removed.

Keywords

Paracentesis Peritonitis Ascites Albumin Coagulopathy 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Emergency MedicineWellSpan York HospitalYorkUSA

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