Display Patient Information Leaflets

Date issued: July 2024

For review: July 2026

Ref: A-633/JM/Oncology/Ultrasound Guided Paracentesis

PDF: Ultrasound Guided Paracentesis.pdf [pdf] 289KB

Introduction

This booklet aims to give you information about having a procedure known as a Paracentesis (para-sen-tea-sis) and the care you will receive before, during and after the procedure. We hope it will answer some of the questions that you or your relatives have at this time. It is not meant to replace the discussion between you and your hospital doctor or clinical nurse specialist but should be used to help you to understand more about what is being discussed.

What is a paracentesis?

Inside the abdomen is a membrane called the peritoneum. The peritoneum covers the organs inside your abdomen and produces a fluid which lubricates these organs and helps them to glide smoothly over one another. This fluid is known as ascites (a-sigh-teas). Sometimes too much of this fluid can be produced causing discomfort and the decision is made to drain this fluid away.

Paracentesis is a procedure in which a small tube connected to a collecting bottle or bag is inserted through your abdominal wall under ultrasound guidance to drain excess fluid from inside your abdomen.  

Why is my doctor/clinical nurse specialist recommending that I have a Paracentesis performed?

The procedure may be performed for therapeutic or diagnostic reasons or for both:

Therapeutic: To relieve pressure from within your abdomen from the build-up of ascites.

Diagnostic: To send a small sample of the ascitic fluid to the laboratory for analysis. You can expect to have the results within a week.

What causes the excessive fluid in the abdomen? 

There are several possible reasons for this build-up of fluid: 

• If cancer cells have spread to the lining of the abdomen, they can cause irritation. This in turn produces a reaction in the body which causes excess fluid to be made and collect in the abdomen.

• If the liver is affected by cancer, it can cause a blockage in the blood circulating through it, leading to a build-up of fluid in the abdomen.

• Alternatively, liver damage can change the body’s fluid balance, causing fluid to build up in the body’s tissues, including the abdomen.

• Cancer can also affect the lymphatic system. This is made up of the tissues and organs that produce and store lymph, as well as the network of vessels carrying lymph fluid throughout the body.

The above list is not exhaustive, and your doctor/clinical nurse specialist may be able to help you further understand why there is excessive fluid in your abdomen.       

Consent

You will be asked to sign a consent form agreeing to the procedure, acknowledging that you have had information about the procedure and that you are aware of the possible risks.

If, after discussion with your hospital doctor or radiologist you do not want the procedure carried out, then you can decide against it.

What happens during the procedure? 

• Before the procedure begins you will be asked to use the toilet and empty your bladder if necessary.

• This is a sterile procedure, and the specialist nurse will wear sterile gloves. Your skin will be cleaned with cold antiseptic liquid and a sterile drape will be placed over you.

• The specialist nurse will first carry out an ultrasound scan of your abdomen to assess the amount of ascites and determine a suitable place to insert the drain.

• The specialist nurse will give you a local anaesthetic; this is an injection to numb the skin around the area where the tube will be inserted. This may sting a little bit for a short while.

• During the procedure, a tube will be inserted into your abdomen and secured by tape.

• The fluid (ascites) will drain through this tube into a drainage bag or bottle. 

After your procedure

You will return to the ward where after 2 hours of bed rest, you will be able to walk around whilst the fluid is being drained into the bag.

Depending on what time the drain is inserted, you may be required to stay overnight, so please be prepared and bring an overnight bag with you.

The nursing staff will check your blood pressure, pulse, temperature, and respiratory rate at set intervals.

The drainage usually takes place over 2-6 hours; however, this length of time can vary from person to person and is affected by:

• How much fluid is in your abdomen, there may be several litres.

• How fit you are.

• How well you feel during the procedure.  

You may experience slight discomfort after the procedure, but it should not be painful.  Painkillers can be given if you experience discomfort, please ask the nursing staff if you feel you require pain relief.

When all the fluid has drained, the tube is removed, and a dressing is placed over the drainage site. Occasionally when the drain is removed, there is leakage of fluid from the small puncture wound until it heals. If this occurs the wound will need to be dressed with an absorbent dressing.  

What are the risks associated with having a Paracentesis? 

• If a large quantity (several litres) of fluid is removed, there is a slight risk of lowered blood pressure. Your blood pressure will be monitored during your hospital stay. Occasionally intravenous fluids (a drip) may be required to help your blood pressure to return to a ‘normal’ value.

• The tube draining the fluid can become blocked. If the tube cannot be unblocked, it may have to be removed and another one inserted.

• The site of the drain can become infected. If this happens you will require antibiotics to treat the infection.

• There is a very small risk that your bowel may be punctured during the procedure. In the unlikely event of this happening, you may require surgery to repair the damaged bowel.

• There is a very small risk of bleeding. Depending on the amount of bleeding this may require iron tablets or a blood transfusion.  

What happens after the Paracentesis is removed?

After the drain is removed you will be discharged home with a dressing over the site.   Ensure that you drink plenty of fluids after you are discharged.

You may feel tired for several days after the fluid has been drained, you may have some abdominal tenderness and may require some simple painkillers such as paracetamol.

If there is an underlying malignancy, unless treatment is initiated (either surgery or chemotherapy), the fluid is likely to build back up, the time it takes for this to happen varies from patient to patient.  

What to look out for:

Observe the site where the drain was inserted.  If it becomes painful, red or develops pus or have a temperature > 37.5^c, please contact the Acute Oncology Team advice line on 01752 202082 Bleep 0023, 24 hours a day.