A+Acute Medical TakeUK Acute Medicine Clinical Guide
Clinical evidenceNICE · Specialist guidance · UpToDate
Current languageEnglish
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STAND-ALONE BEDSIDE PROCEDURE PATHWAY

Abdominal paracentesis

Ultrasound-selected diagnostic tap or controlled large-volume drainage
Ultrasound-guided abdominal paracentesis from safe-site selection through drainage and monitoring
1Ultrasound2Sterile prep3Local anaesthetic4Drain + sample5Monitor

Indications

  • New ascites, hospital admission with cirrhosis or clinical deterioration
  • Suspected spontaneous bacterial peritonitis
  • Tense/symptomatic or malignant ascites requiring therapeutic drainage

Stop / escalate

  • No safe pocket or uncertain anatomy—use ultrasound/expert operator
  • DIC or clinically significant bleeding risk requires individual correction plan
  • Acute abdomen, loculation, pregnancy or organomegaly changes site/operator strategy

Illustrated step sequence

1Confirm purpose, consent and tests; ultrasound a pocket away from epigastric vessels
2Asepsis, local anaesthetic and diagnostic needle or drainage catheter
3Collect diagnostic fluid before antibiotics when safe—never delay sepsis treatment
4For large-volume drainage secure catheter, record volume/time and monitor BP/symptoms
5Remove catheter promptly when complete; dress and document

Samples / technical essentials

  • Cell count with neutrophils—PMN ≥250 cells/mm³ supports SBP treatment
  • Albumin and paired serum albumin for SAAG; total protein
  • Bedside inoculation into aerobic/anaerobic blood-culture bottles; cytology/other tests by phenotype

Aftercare and complications

  • Albumin: 8 g per litre removed when >5 L drained; consider with smaller volumes if high AKI risk per specialist guidance
  • Monitor BP, pain, leakage, bleeding, renal function and sodium
  • Escalate peritonism, haemorrhage, persistent leak, hypotension or AKI

Supervised clinician education. Use the current local checklist, competency standard, consent policy, infection-control procedure and escalation route. This pathway does not certify procedural competence.

Other bedside procedures

Lumbar puncture→Blood cultures→Chest-drain insertion→Venepuncture→Arterial blood gas sampling→