Laparocentesis
Written by Rhiana Devadasan
Laparocentesis: (AKA paracentesis, peritoneocentesis or abdominal paracentesis) a procedure in which the peritoneal cavity is punctured by a needle to gain access to peritoneal fluid (either for diagnostic or therapeutic purposes).
Procedure:
- Needle is inserted into the peritoneal cavity.
- Diagnostic/therpeutic procedure is performed (e.g. Ascetic fluid is removed).
Diagnostic = small quantities of fluid is removed for testing
Therapeutic = >5L of fluid removed (to ↓intraabdominal pressure & relieve symptoms like dyspnea, abdominal pain, early satiety).
Indications & Examples
- Used to remove fluid from the peritoneal cavity (especially when this cannot be achieved w/medication).
- Ascites (e.g. in people with liver cirrhosis).
- To diagnose spontaneous bacterial peritonitis & other infections (e.g. abdominal TB).
- To diagnose metastatic cancer.
- To diagnose blood in peritoneal space in trauma.
- Patients presenting ascites + symptoms:
- Fever
- Abdominal pain
- Hepatic encephalopathy
- ↓Renal function
- Metabolic acidosis
Contraindications
- Patient with DIC
- Primary fibrinolysis
- Massive ileus with bowel distension
- Near the surgical scar (possible bowel perforation)
- Infection Complications
- Ascetic fluid leak
- Bleeding (Artery or vein)
- Inferior epigastric bleed – use a figure of 8 suture surrounding the needle site
- Rarely laparotomy is needed to control bleeding in patients w/ renal failure and hyperfibrinolysis
- Bowel perforation
- Infections
- Catheter residue broken into abdo wall