Ultrasound-Guided Paracentesis

Paracentesis is an invasive procedure that involves the insertion of a needle into the peritoneal cavity to remove ascitic fluid [1]. In general, any patient who presents to the emergency department with ascites without a previous diagnosis, or with an infectious condition and suspected bacterial peritonitis, should have peritoneal fluid collected and sent for analysis [2]. This procedure may serve a diagnostic purpose, through collection and culture of ascitic fluid, as well as a therapeutic purpose.
In cases of large-volume ascites, which can compress and distend abdominal structures, patients may complain of pain, abdominal discomfort, or respiratory difficulty due to diaphragmatic compression. In such situations, therapeutic paracentesis is indicated to relieve symptoms. The use of point-of-care ultrasound (POCUS) in the emergency department has provided greater safety and accuracy when performing the procedure. Ultrasound-guided paracentesis has a success rate of approximately 95%, compared with about 65% using the traditional landmark-based technique [3].