Indications
- • New ascites
- • Suspected SBP (any cirrhotic with ascites + fever/abdo pain/decline)
- • Tense or symptomatic ascites (therapeutic)
Contraindications
- ⚠ DIC, severe coagulopathy (relative)
- ⚠ Bowel obstruction / pregnancy without USS
- ⚠ Skin infection
Equipment
- • USS
- • Sterile pack, chlorhexidine, drapes
- • 1% lidocaine
- • 21G needle + 20 mL syringe for diagnostic
- • Bonanno or pigtail drain set for therapeutic
- • Blood culture bottles + universal containers
- • 20% human albumin (8 g per L removed)
Technique
- • USS-mark — typically LIF, lateral to rectus, away from organomegaly + scars
- • Sterilise, drape, infiltrate with lidocaine to peritoneum
- • Diagnostic: insert needle perpendicular, aspirate 20 mL — send urgently
- • Therapeutic: Z-track technique → Seldinger pigtail, secure, free drainage
- • Replace albumin 8 g per L removed if >5 L
Complications
- ⚠ Bleeding (esp varices on abdo wall)
- ⚠ Bowel perforation
- ⚠ Hypotension after large-volume drainage
- ⚠ Hepatorenal syndrome
- ⚠ Infection
Aftercare
- • Cap or remove drain by 6 h to reduce infection
- • Monitor BP, U&E, weight
- • Send: cell count + differential (SBP if neutrophils ≥250), MC&S in blood culture bottles, albumin, protein, glucose, amylase, cytology
Clinical pearls
- • SAAG = serum − ascites albumin; ≥1.1 = portal hypertension
- • Start empirical 3rd-gen cephalosporin if SBP suspected
- • Always replace albumin in large-volume paracentesis
Perform under supervision until competent. Follow local SOPs and consent policy.
