Paracentesis for Ascites

Posted by e-Medical PPT Sunday, October 3, 2010
Paracentesis is a medical procedure involving needle drainage of fluid from a body cavity,most commonly the peritoneal cavity.Paracentesis for Ascites is usually safe, although there is a very small risk of introducing an infection, causing excessive bleeding or perforating a loop of bowel.During the procedure, patients are asked to expose their abdomen. After cleaning the side of the abdomen with an antiseptic solution, physicians will numb a small area of skin and then insert a fairly large-bore needle 2 to 5 cm to reach the peritoneal cavity.The needle is then removed, leaving the plastic sheath behind to allow drainage of the fluid. The fluid can be drained by gravity or by connection to a vacuum bottle. Up to 11 litres of fluid may be drained during the procedure. If fluid drainage is more than 5 litres, patients may receive intravenous serum albumin (25% albumin, 8g/L) to prevent hypotension.
The serum-ascites albumin gradient (SAAG) is a calculation used in medicine to help determine the cause of ascites.A high gradient (more than 1.1 g/dL) indicates the ascites is due to portal hypertension with 97% accuracy.This is due to increased hydrostatic pressure within the blood vessels of the hepatic portal system.Other causes of high SAAG ascites include:heart failure,cirrhosis of the liver and Budd Chiari syndrome.A low gradient (less than 1.1 g/dL) indicates ascites not associated with increased portal pressure, including nephrotic syndrome, tuberculosis, and various types of cancer.

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