Ascites Puncture

Ascites puncture

An ascites puncture involves drawing fluid from the abdomen. Due to pathological processes, this accumulates between the leaves of the peritoneum. The puncture can be made for diagnostic purposes. However, a puncture - also called paracentesis - is performed for therapeutic reasons…

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• When is an ascites puncture necessary?
• What preparations are necessary?
• How does the ascites puncture work?
• What are the side effects / complications?
• Whom can I ask?

When is an ascites puncture necessary?

An ascites puncture is necessary in order to clarify the causes of ascites in the course of the diagnosis. Reasons for ascites can be:

• Liver disease (cirrhosis of the liver, alcoholic hepatitis),
• Budd-Chiari syndrome, sinusoidal obstruction syndrome,
• Cancer (peritoneal metastases, liver malignancy),
• Heart failure (right heart failure, constrictive pericarditis, global heart failure),
• Peritonitis (tubercular, bacterial),
• Nephrotic syndrome,
• Malnutrition (lack of protein),
• Pancreatitis and much more.

As part of the therapy, the puncture is performed in order to "drain" larger amounts of fluid and to alleviate symptoms (such as pain, difficult breathing). This is the case, for example, with pronounced ascites and / or when other therapeutic measures are unsuccessful.

What preparations are necessary?

The patient's state of health is clarified in advance of a planned intervention. Various examinations are carried out (e.g. ultrasound, blood clotting). Among other things, the medical history of illnesses (e.g. cardiovascular diseases, allergies), the use of medication (e.g. blood-thinning medication) and whether there has already been ascites etc. are essential. Before the planned ascites puncture, the doctor will inform you about the procedure and its process. Open questions can be clarified. The bladder should be emptied before the puncture.

How does the ascites puncture work?

The puncture is performed in the supine position or with a slight physical rotation. The doctor localizes the puncture site (usually using ultrasound) and marks it. The lateral lower abdomen is punctured. The area of skin is shaved if necessary. It is also disinfected and covered in a sterile manner. The doctor works under sterile conditions and with sterile material.

A local anesthetic can be injected if necessary. The puncture needle is then inserted perpendicular to the surface of the skin using a syringe and carefully advanced. As soon as fluid can be seen, an infusion tube with a collection bag or container is connected (when collecting for therapeutic purposes). As part of the diagnosis, a corresponding proportion of the punctured liquid is removed with the syringe and sent to a diagnostic laboratory. It can also be drawn up with the syringe (when removing it for diagnosis).

At the end of the sampling, the needle is removed, the puncture area is pressed with a sterile compress and a sterile plaster is applied. If necessary, a compression bandage can be applied, in rare cases a suture is necessary.

Samples taken are used for further examination in the laboratory. Various values are collected, e.g. total protein, albumin, tests for germs, cancer cells and much more. After the puncture, blood pressure, pulse, liver and kidney values are checked.

What are the side effects / complications?

If you suffer from bleeding disorders, you should definitely tell the doctor. Circulatory problems can occur especially with large amounts of withdrawn fluid - up to a hepatorenal syndrome. Therefore, in these cases an infusion with a special solution (plasma expander) is administered. Complications that can occur are, for example, bleeding, infections, injuries to organs (eg urinary bladder, intestines).

Whom can I ask?

An ascites puncture is performed in the hospital (internal medicine, gastroenterology). Depending on the situation, you may need a certificate of admission or referral from your treating doctor. For more information, see Well prepared for the hospital.