Paracentesi

Paracentesi, or paracentesis, is a medical procedure in which fluid is removed from the peritoneal cavity through a needle or small catheter. It is performed for diagnostic or therapeutic reasons and is most commonly used to manage ascites, the abnormal accumulation of fluid in the abdominal cavity.

Indications include diagnostic analysis of ascitic fluid to determine the cause (for example liver disease, infection, or malignancy); measurement of parameters such as protein concentration and the serum-ascites albumin gradient (SAAG); and therapeutic relief of symptoms from large-volume ascites, including shortness of breath and abdominal discomfort. In some settings, ascitic fluid may be sampled for cytology or culture to detect infection or cancer. After fluid removal in large-volume procedures, albumin may be given to help prevent circulatory dysfunction.

Technique typically involves ultrasound guidance to identify a fluid pocket and avoid vessels, followed by aseptic preparation, local anesthesia, and insertion of a needle or small catheter into the abdomen. The procedure is generally well tolerated, and the patient is monitored for signs of fluid shifts or infection. It is often performed at the bedside or in an interventional radiology suite.

Potential complications include bleeding, infection, injury to intra-abdominal organs, hypotension or hypovolemia, electrolyte disturbances, and, rarely, peritoneal or systemic infection. Contraindications include uncorrected coagulopathy or infection at the puncture site, and actual risk is weighed against symptomatic benefit. Recurrence of ascites is common, necessitating repeated procedures or alternative management.