Since we have covered so many other procedures I though I would include paracentesis for completion.
A diagnostic paracentesis (typically 30-60 ml) is indicated to:
Determine etiology of new ascites (transudate vs exudate, cancer, infection)
Rule out spontaneous bacterial peritionitis...(suspect this in any patient with a history of ascites that has fever, mental status changes, or diffuse abdominal pain)
A therapeutic paracentesis (large volume >1L) is indicated in the emergency department for:
Respiratory distress from abdominal distension
Abdominal compartment syndrome. See Dr. Winters Pearl
Remember large volume paracentesis can result in profound fluid shifts and subsequent hypotension.
Absolute Contraindications to paracentesis include: Acute abdomen requiring surgery
Relative contraindications are:
Platelets <20,000
INR > 2
Pregnancy
h/o adhesions
abdominal wall cellulitis (just don't stick the needle through the cellulitis)
