Drainage of abdominal fluid (abdominal paracentesis)

This leaflet is designed to explain what happens when someone requires abdominal paracentesis. If you have any questions or concerns, please speak to your doctor or nurse.

Ascites is the medical term used to describe the build up of fluid inside the abdominal cavity (tummy). In a healthy person, the body normally produces a small amount of fluid in the abdomen; this is constantly produced and reabsorbed. However, in certain conditions such as liver disease or cancer, there is an imbalance of fluid production and absorption and this causes too much fluid to build up in the abdomen.

• Abdominal swelling.
• Abdominal discomfort/pain.
• Shortness of breath.
• Fatigue.
• Nausea and vomiting.
• Indigestion.
• Poor appetite.
• Reduced mobility.
• Constipation or diarrhoea.

We can ease some of the symptoms of ascites by removing the excess fluid in the abdomen. We can do this by:

• Medications called diuretics (water tablets)
• Inserting a temporary plastic tube into the abdomen to drain off the excess fluid (abdominal paracentesis).

Abdominal paracentesis usually provides immediate relief of symptoms. Diuretics can take longer to work and can have side effects. People with ascites often require both medications and drainage to manage their symptoms.

• Before your procedure, a small plastic tube called a cannula or ‘drip’ will be inserted into a vein. This is typically in your arm or back of your hand. This is needed to give you some Albumin (one of the body’s proteins) via the cannula during the procedure, which reduces complications of the procedure.
• You will be required to lie on a bed and the Doctor or Nurse will examine you and decide where the best place to insert the drain will be. Sometimes an ultrasound machine may need to be used. This is usually in the right or left lower part of your abdomen.
• Once the appropriate site for the drain is chosen, the Doctor or Nurse will put on sterile gowns and gloves and the site on your abdomen is thoroughly cleaned.
• A small injection of local anaesthetic is given to numb the area where the drain is to be inserted.
• After the anaesthetic has started to work, a very small cut is made into the skin and a thin tube is inserted through the cut into the abdominal cavity.
• The tube is attached to a drainage bag to collect the fluid.
• Some of the fluid will be sent to the lab for analysis and the results of this will be available later that day.
• The tube is fastened to the skin with sticky dressings. Your nurse will do regular observations on you including your blood pressure, heart rate and temperature.
• The drain will typically stay in for no longer than 6 hours OR for 12 litres of fluid to drain (whichever is sooner).
• The fluid drained is usually replaced at the same time with the Albumin solution through the ‘drip’.
• It is safe for the procedure to be performed whilst on low molecular weight heparin.

Drainage of abdominal fluid

After the fluid has drained you will be asked to lie on the bed and the nurse will remove the drain which is quick and painless. A waterproof dressing will be placed over the area and should be kept in place and dry for 48 hours. Your cannula will be removed.

Abdominal paracentesis is a safe procedure with a very small rate of significant complications (less than 1 in 1000 people).

Some of the common risks are:

• Lethargy
• Slight increase in abdominal discomfort
• Leakage from the drain site (for up to 3 days after the procedure).
• Failure to drain fluid.

Rarer complications are:

• Infection of the skin/abdominal cavity
• Bleeding
• Low blood pressure
• Damage to internal organs (bowel/liver/spleen).