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    Paracentesis

    Paracentesis

    Test Overview

    Paracentesis is a procedure to take out fluid that has collected in the belly ( peritoneal fluid ). This fluid buildup is called ascites . Ascites may be caused by infection, inflammation, an injury, or other conditions, such as cirrhosis or cancer. The fluid is taken out using a long, thin needle put through the belly. The fluid is sent to a lab and studied to find the cause of the fluid buildup. Paracentesis also may be done to take the fluid out to relieve belly pressure or pain in people with cancer or cirrhosis.

    Why It Is Done

    Paracentesis may be done to:

    • Find the cause of fluid buildup in the belly.
    • Diagnose an infection in the peritoneal fluid.
    • Check for certain types of cancer, such as liver cancer.
    • Remove a large amount of fluid that is causing pain or trouble breathing or that is affecting how the kidneys or the intestines (bowel) are working.
    • Check for damage after a belly injury.

    How To Prepare

    Before you have paracentesis done, tell your doctor if you:

    Other blood tests may be done before a paracentesis to make sure that you do not have any bleeding or clotting problems. You will empty your bladder before the procedure.

    You may be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

    Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?) .

    How It Is Done

    This procedure may be done in your doctor's office, an emergency room, or the X-ray department of a hospital, or at your bedside in the hospital.

    If a large amount of fluid is going to be taken out during the procedure, you may lie on your back with your head raised. People who have less fluid taken out may sit up. The site where your doctor will put the needle is cleaned with a special soap and draped with sterile towels.

    Your doctor puts a numbing medicine into your belly. Once the area is numb, your doctor will gently and slowly put the paracentesis needle in where the extra fluid is likely to be. Your doctor will be careful to not poke any blood vessels or the intestines. If your test is done in the X-ray department, an ultrasound may be used to show where the fluid is in your belly.

    If a large amount of fluid is present, the paracentesis needle may be hooked by a small tube to a vacuum bottle for the fluid to drain into it.

    Generally, up to 4 L (1 gal) of fluid is taken out. If your doctor needs to remove a larger amount of fluid, you may be given fluids through an intravenous line (IV) in a vein in your arm. This fluid is needed to prevent low blood pressure or shock . It is important that you lie completely still during the procedure, unless you are asked to change positions to help drain the fluid.

    When the fluid has drained, the needle is taken out and a bandage is placed over the site. After the test, your pulse, blood pressure, and temperature are watched for about an hour. You may be weighed and the distance around your belly may be measured before and after the test.

    Paracentesis takes about 20 to 30 minutes. It will take longer if a large amount of fluid is taken out. You can do your normal activities after the test unless your doctor tells you not to.

    How It Feels

    You may feel a brief, sharp sting when the numbing medicine is given. When the paracentesis needle is put into your belly, you may feel a temporary sharp pain or pressure.

    You may feel dizzy or lightheaded if a large amount of fluid is taken out. Tell your doctor if you do not feel well during the test.

    After the procedure, you may have some clear fluid draining from the site, especially if a large amount of fluid was taken out. The drainage will get less in 1 to 2 days. A small gauze pad and bandage may be needed. Ask your doctor how much drainage to expect.

    Risks

    There is a very small chance that the paracentesis needle may poke the bladder, bowel, or a blood vessel in the belly.

    If cancer cells are present in the peritoneal fluid, there is a small chance that the cancer cells may be spread in the belly.

    If a large amount of fluid is removed, there is a small chance that your blood pressure could drop to a low level. This could lead to shock. If you go into shock, IV fluids or medicines, or both, may be given to help return your blood pressure to normal. There is also a small chance that removing the peritoneal fluid may affect how your kidneys work. If this is a concern, IV fluids may be given during the paracentesis.

    After the test

    Call your doctor immediately if you have:

    • A fever higher than 100 F (38 C).
    • Severe belly pain.
    • More redness or tenderness in your belly.
    • Blood in your urine.
    • Bleeding or a lot of drainage from the site.

    Results

    Paracentesis is a procedure to take out fluid that has collected in the belly ( peritoneal fluid ). This fluid buildup is called ascites . The fluid taken from your belly will be sent to a lab to be studied and looked at under a microscope. Results will be ready in a few hours.

    Paracentesis
    Normal:

    No infection, cancer, or abnormal values are found.

    Abnormal:

    Several tests may be done on the fluid.

    • Cell counts. A high number of white blood cells (WBCs) in the fluid may mean inflammation, infection ( peritonitis ), or cancer is present. A high WBC count and a high count of WBCs called polymorphonuclear leukocytes (PMNs) may mean there is an infection inside the belly called spontaneous bacterial peritonitis (SBP).
    • Serum-ascites albumin gradient (SAAG). The SAAG compares the level of protein in the fluid to the level of protein in the blood. High protein levels in the fluid may mean cancer, tuberculosis , nephrotic syndrome , or pancreatitis . Low protein levels in the fluid may mean cirrhosis or clots in veins of the liver are present.
    • Culture. A culture can be done on the fluid to see whether bacteria or other infectious organisms are present.
    • Lactate dehydrogenase (LDH). High levels of the enzyme LDH may mean infection or cancer is present.
    • Cytology. Abnormal cells in the fluid may mean cancer is present.
    • Amylase. High levels of amylase may mean pancreatitis or that there is a hole in the intestine.
    • Glucose. Low levels of glucose may mean infection.

    What Affects the Test

    Reasons you may not be able to have the test or why the results may not be helpful include:

    • Using blood thinners (anticoagulants) or aspirin, which can increase the chance of bleeding.
    • Having blood, bile, urine, or feces in the fluid sample.
    • Not being able to stay still during the test.
    • Being obese .
    • Having scars inside the belly ( adhesions ) from any belly surgery in the past.

    What To Think About

    Sometimes doctors use fluids put into the belly to check for injuries. This is called peritoneal lavage. During this procedure, a doctor uses a paracentesis needle to put a salt (saline) fluid into the belly. The fluid is then taken out through the same needle. If the fluid that comes out is bloody, the bleeding is probably being caused by an injury inside the belly.

    References

    Other Works Consulted

    • Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
    • Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
    • Pagana KD, Pagana TJ (2010). Mosby?s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.

    Credits

    By Healthwise Staff
    E. Gregory Thompson, MD - Internal Medicine
    Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
    Last Revised March 8, 2013

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