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Your doctor recommends that you have paracentesis to remove excess fluid from your abdomen (belly). A needle is used to drain the fluid. A small sample of fluid may be taken and tested for problems. If the fluid buildup is causing discomfort or pain, all of the fluid may be drained. To do this, a tube is attached to the needle. The fluid is drained into a container that sits outside of the body. If symptoms are severe, paracentesis may be done as an emergency procedure. Otherwise, it will be scheduled ahead of time. Read on to learn more about paracentesis and how it works. 

Outline of woman's abdomen showing abdominal organs. Abdominal wall is lined on inside with peritoneum. Fluid is filling abdomen under peritoneum and around organs. Tube is inserted through skin into abdomen to drain fluid out.

Understanding ascites

Many of the body’s organs, including the liver and intestines, are inside the abdomen. The organs are covered in a thin membrane called the peritoneum. The peritoneum has two layers. The membrane makes a fluid that allows the layers to glide smoothly past each other. If this fluid builds up in the abdomen, the condition is called ascites. Ascites causes pain and discomfort. It can also make it hard to breathe. Fluid can build up for a number of reasons. Some of these include chronic liver disease (cirrhosis), heart or kidney failure, and cancer. Your doctor can tell you more about the cause of your ascites.

How paracentesis works

The goal of paracentesis may be to help diagnose the cause of the excess fluid. Or, the goal may be to drain excess fluid from the abdomen. In some cases, fluid returns and the procedure needs to be repeated.

Before the procedure

  • Tell your doctor about all medications you take. Also, mention any allergies you have.

  • Before the procedure begins, you’ll be asked to empty your bladder. This helps prevent injury to the bladder during the procedure. If needed, a thin tube (Foley catheter) may be placed into your bladder to drain urine during the procedure. This tube is removed after the procedure.

  • An IV line may be put into a vein in your arm or hand. This line supplies fluids and medications.

During the procedure

  • You are awake during the procedure.

  • An imaging method called ultrasound may be used to guide the procedure. It shows live images of the inside of your abdomen on a video screen. This helps the doctor locate the site of the excess fluid inside your abdomen and decide where to insert the needle.

  • Local anesthesia (numbing medication) is injected into the skin of the abdomen where the needle will be inserted.

  • Once the skin is numb, the doctor carefully inserts the needle into the abdomen. This causes the needle to fill with fluid.

  • The needle may be removed with only a small sample of fluid. This sample is sent to a lab for testing. Obtaining a sample takes about 10 to15 minutes.

  • Or, a tube may be attached to the needle so that more of the excess fluid can be drained. The tube may be taped or stitched into place. This keeps it from pulling the needle out of your abdomen.

  • How long it takes to drain all of the fluid varies for each person. In most cases, it takes about 30 minutes. Your doctor will let you know if the procedure is expected to take longer than usual.

  • Once all of the fluid is drained, the needle and tube are removed.

  • Pressure is put on the puncture site to stop any fluid leakage or bleeding.

  • A small bandage is placed over the puncture site. Albumin may be given during or after the procedure to prevent low blood pressure or kidney problems.

After the procedure

You may be taken to a recovery room to rest after the procedure. If you are in pain, you will be given medication as needed. You will likely be sent home 1 to 2 hours after the procedure is done. When you leave the hospital, have an adult family member or friend drive you home.

Risks and possible complications of paracentesis

The procedure is considered safe. But like all procedures, it carries some risks. These include the following:

  • Bleeding

  • Infection

  • Injury to structures in the abdomen

  • Fast drop in blood pressure

Recovering at home

  • If needed, your doctor can prescribe or recommend pain medications for you to take at home. Take these exactly as directed. If you stopped taking other medications before the procedure, ask your doctor when you can start them again.

  • You may remove the bandage 24 hours after the procedure.

  • Take it easy for 24 hours after the procedure. Avoid physical activity until your doctor says it’s OK

Follow-up care

Make a follow-up appointment with your doctor as directed. During your follow-up visit, your doctor will check your healing. Let your doctor know how you are feeling. You can also discuss the cause of your ascites and whether any further treatment is needed.

When to seek medical care

Call your doctor if you notice any of the following after the procedure:

  • A fever of 100.4°F (38.0°C) or higher

  • Trouble breathing

  • Pain that does not go away even after taking pain medication

  • Abdominal pain not caused by having the skin punctured

  • Bleeding from the puncture site

  • More than a small amount of fluid leakage from the puncture site

  • Swelling of the abdomen

  • Signs of infection at the puncture site. These include increased pain, redness, or swelling, warmth, or foul-smelling drainage.

  • Blood in your urine

  • Dizziness, lightheadedness, or fainting