Indications & Contraindications
This is the main reason to perform a diagnostic paracentesis in a patient with new-onset ascites.
What is to determine the cause of ascites?
Positioning the patient in this manner facilitates a safe paracentesis.
What is lying supine with the head elevated 30-45 degrees?
After removing fluid, pressure should be applied to prevent this complication.
What is a hematoma or bleeding?
HRS is a type of this kind of renal failure that occurs in cirrhosis
What is functional (intrinsic) renal failure?
This is a common symptom that indicates therapeutic paracentesis might be needed.
What is tense or refractory ascites causing discomfort or dyspnea?
The ideal site for needle insertion during paracentesis
What is 2-4 cm lateral and cephalad to the umbilicus?
This monitoring is essential after paracentesis to catch complications early.
What is monitoring for bleeding, infection, and hypotension?
Serum creatinine level above this value is one of the diagnostic criteria for HRS.
What is greater than 1.5 mg/dL
Absolute contraindication to paracentesis related to blood clotting.
What is uncorrected coagulopathy (e.g., INR >1.5 or platelet count 250 cells/mm³)?
Before inserting the needle, this should be thoroughly prepared.
What is the skin and the surrounding area (sterile prep)?
Sending the aspirated fluid for these analyses helps determine the cause of ascites.
What are cell count, culture, albumin, and cytology?
This is a key feature of HRS that differentiates it from other kidney injuries.
What is no improvement after volume expansion?
This is a relative contraindication that requires caution during paracentesis.
What is hemodynamic instability or bowel obstruction?
This local anesthetic is used to numb the area before needle insertion.
What is lidocaine without epi?
This calculation helps differentiate between different causes of ascites, especially in cirrhotic patients.
What is the serum-ascites albumin gradient (SAAG)?
The primary pathophysiological process leading to HRS.
What is severe vasoconstriction of renal circulation due to splanchnic vasodilation?
Use of this imaging modality can improve the safety of paracentesis.
What is ultrasound guidance?
Inserting the needle or catheter should be done slowly to avoid this complication.
What is bowel perforation or bleeding?
This is a potential, but rare, complication of paracentesis that involves the loss of continuity within the intestinal wall.
What is a bowel perforation?
Management of HRS often includes this medication class to constrict renal blood vessels.