A paracentesis is a medical procedure used to remove abnormal fluid accumulation (ascites) from the abdominal cavity. This fluid buildup often occurs due to underlying conditions, most commonly severe liver disease. The process involves inserting a small needle or catheter through the abdominal wall into the peritoneal space. Paracentesis is performed either for diagnostic purposes (to obtain a fluid sample for testing) or therapeutically (to drain a significant volume of fluid). Removing the fluid alleviates uncomfortable pressure, abdominal distension, and difficulty breathing.
Identifying the Performing Specialist
The medical professional who performs a paracentesis is not limited to a single specialty. Gastroenterologists and Hepatologists, who specialize in liver and digestive diseases, frequently perform this procedure. Ascites is a common complication of advanced liver disease, making these specialists primary providers.
Interventional Radiologists (IR) also perform paracentesis, particularly when precise imaging guidance is required. They use real-time ultrasound to identify the safest insertion point, avoiding blood vessels or bowel loops. This image-guided approach is preferred for patients with complex anatomy, minimal fluid, or prior abdominal surgery.
In some hospital settings, Hospitalists or Internal Medicine physicians may perform the procedure directly at the patient’s bedside for simpler cases. However, the use of bedside procedures by non-radiology specialists has decreased. This shift reflects a move toward greater procedural safety and efficacy offered by consistent imaging use.
Typical Locations for the Procedure
The location for a paracentesis varies widely depending on the performing specialist and the patient’s health status. When performed by an Interventional Radiologist, the procedure most often occurs in a dedicated Interventional Radiology Suite. These specialized rooms contain the high-quality, real-time imaging equipment needed for precise, image-guided access.
Gastroenterologists may conduct the procedure in a specialized Endoscopy Unit or a dedicated GI Procedure Suite. For hospitalized patients, a non-complex paracentesis may be performed at the patient’s bedside within the general medical ward. Bedside procedures are typically chosen for therapeutic removal when a patient is too unwell to be moved.
Outpatient clinics and dedicated infusion centers also serve as locations, especially for patients requiring frequent, scheduled therapeutic paracentesis. The choice of setting balances patient comfort, the need for advanced imaging, and the required level of post-procedure monitoring.
Patient Preparation and Logistics
Proper preparation minimizes risks and ensures a successful paracentesis. Before the procedure, the medical team obtains informed consent detailing the steps, potential outcomes, and complications. Blood tests are performed to check the patient’s coagulation status and evaluate the risk of bleeding.
Patients are often instructed to stop taking certain blood-thinning medications, such as warfarin, a few days prior, following physician guidance. The patient must also empty their bladder completely just before the procedure to reduce the risk of accidental puncture. An ultrasound is frequently used to accurately locate the fluid pocket and mark the safest insertion site on the abdomen.
Post-Procedure Care and Monitoring
After the catheter or needle is withdrawn, a sterile dressing is applied to the puncture site, and mild pressure is held to stop immediate bleeding. Following large-volume paracentesis (removing more than five liters), an infusion of intravenous albumin may be administered. This protein replacement helps prevent a significant drop in blood pressure and circulatory problems.
The patient’s vital signs, including blood pressure and heart rate, are monitored for one to four hours. The site is regularly checked for persistent fluid leakage, a common but minor complication that resolves with a simple bandage change. Patients are instructed to watch for signs of complications, such as fever, excessive drainage, severe abdominal pain, or heavy bleeding, and to seek immediate medical attention.