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 >or=250 cells/mm(3) 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.

Clinical relevance and contemporary methods for counting blood cells in body fluids suspected of inflammatory disease

“…Sensitivity varied from 86% to 100% and specificity between 93% and 98% when PMNs were > 500 × 10 6 /L [35,59]. Further attempts to increase the diagnostic ability of the PMN count led to higher sensitivity (90%-100%) and slightly lower specificity (86%-100%) when the cut-off criterion was set to ≥ 250 × 10 6 PMN/L [36,60]. In summary, PMN ≥ 250 × 10 6 /L shows optimal sensitivity to detect SBP; whereas, PMN > 500 × 10 6 /L is more specific ( Table 1).…”

Cirrhosis with ascites: Is the presence of hemorrhagic ascites an indicator of poor prognosis?

“…Patients with hemorrhagic ascites were divided two groups, which were 10,000-50,000/mm³and more than 50,000/mm³. There were twenty patients (16.9%) who had RBC ≥50,000/mm 3 . These two groups were compared for AKI, HES, SBP and admission to ICU and showed no statistical difference from each other in p values, with values of 0.544, 0.516, 0.115, and 0.996 (Table 5).…”

Large-Volume Paracentesis: A Fast, Convenient, and Safe Technique

“…Paracentesis and albumin infusion is applied to tense ascites. Transjugular intrahepatic portosystemic shunt or, in its absence, large-volume paracentesis (LVP), is considered for refractory ascites (2). With worsening of liver disease, fluid retention is associated with other complications such as spontaneous bacterial peritonitis.…”