Parazentese

Parazentese, or paracentesis, is a medical procedure that involves puncturing a body cavity to withdraw fluid or gas for diagnostic or therapeutic purposes. It is most commonly performed in the peritoneal cavity to remove ascitic fluid, but it can also be used to drain pleural or pericardial effusions.

Indications include diagnostic evaluation of ascitic fluid, such as infection (spontaneous bacterial peritonitis), malignancy, or portal hypertension; therapeutic relief of symptomatic ascites or pleural effusion; and preoperative assessment when fluid overload impairs respiratory or circulatory function.

Contraindications include uncorrected coagulopathy or thrombocytopenia, infection at the intended puncture site, severe hemodynamic instability, and, in some cases, inaccessible fluid or suspected organ injury. Risks include bleeding, infection, perforation of viscera, pneumothorax (more with chest procedures), hypotension, and reaccumulation of fluid.

Technique: ultrasound guidance is commonly used to locate fluid and avoid structures. The patient is positioned (sitting upright for pleural; supine or semi-recumbent for ascites). The skin is cleansed and locally anesthetized. A needle or small catheter is introduced into the fluid collection, fluid is withdrawn gradually, and samples may be collected for laboratory analysis (cell count, chemistry, cultures, cytology, SAAG calculation). For large-volume ascites removal, intravenous albumin may be given to reduce circulatory dysfunction (roughly 6-8 g per liter removed).

Post-procedure care includes monitoring vital signs, assessing the puncture site for bleeding or infection, and ensuring patient comfort. Complications are uncommon but warrant prompt evaluation.