Ascites is a medical condition characterized by the abnormal accumulation of fluid within the abdominal cavity, often causing noticeable swelling of the belly. This fluid buildup can lead to discomfort, a feeling of fullness, and even shortness of breath. When conservative treatments like diet and medication are insufficient, a procedure known as paracentesis is commonly performed to remove the excess fluid and alleviate these symptoms.
The Ascites Drainage Procedure
Paracentesis involves the controlled removal of fluid from the abdominal cavity using a thin needle or catheter. The procedure typically begins with the patient in a comfortable position, often lying on their back with the head slightly elevated. A medical professional then cleans and numbs a small area of the abdomen with a local anesthetic.
Once the area is numb, a needle, often guided by ultrasound to ensure precision and avoid vital structures, is carefully inserted through the skin and into the fluid-filled space. A flexible tube, or catheter, may then be threaded over the needle to allow for continuous drainage. The fluid is collected into a sterile container.
Determining Safe Drainage Volumes
There is no universal “per day” amount of ascites that can be drained, as the volume removed is highly individualized and determined by various patient factors. Healthcare providers assess each patient’s symptoms, overall health, and the underlying cause of the ascites to decide on an appropriate volume. For therapeutic purposes, especially to relieve significant symptoms, a procedure known as large-volume paracentesis (LVP) is often performed.
During LVP, it is common to drain 5 to 6 liters of fluid in a single session, and sometimes even more, depending on the patient’s tolerance and the extent of fluid accumulation. Some cases have reported removal of significantly larger volumes, such as 29 liters, when indicated by severe symptoms like respiratory distress.
Understanding Drainage Limits and Risks
While large volumes of ascites can be safely removed, certain limits and potential complications exist, particularly those related to the volume or rate of fluid removal. A significant concern is post-paracentesis circulatory dysfunction (PPCD), also known as paracentesis-induced circulatory dysfunction (PICD). This condition can occur after large-volume drainage and may lead to a rapid reaccumulation of ascites, low blood pressure, and impaired kidney function. PPCD is associated with faster ascites recurrence, electrolyte imbalances, and can impact patient survival.
To prevent PPCD, especially when more than 5 liters of fluid are drained, intravenous albumin is often administered during or after the procedure. Albumin helps to maintain blood volume and stabilize circulation following the removal of large fluid amounts. Other risks of the procedure include minor bleeding at the insertion site, infection, or, in rare instances, injury to internal organs like the bowel. Fluid leakage from the puncture site can also occur, though it is often self-limiting.
After the Drainage Procedure
Following an ascites drainage procedure, medical staff will monitor vital signs and the drainage site. While the procedure provides symptomatic relief, it does not address the underlying cause of the fluid accumulation.
Ascites often recurs, necessitating ongoing management of the underlying condition, which is frequently liver disease. Long-term strategies may involve dietary modifications, such as limiting sodium intake, and the use of diuretic medications. In some cases of recurrent or refractory ascites, repeated paracentesis sessions or other interventions like a long-term drain may be considered to maintain comfort and quality of life.