OVERVIEW
Before conducting a paracentesis, the patient who will receive the procedure (or their respective representative/guardian/power of attorney) will need to consent to the procedure. This page will cover information specific obtaining consent for a paracentesis, however for more general information regarding consenting patients for interventional radiology cases refer to the following page: Interventional Radiology Fundamental Peri-Procedural Tasks: Consenting The Patient.
GENERAL RISKS TO DISCUSS FOR A PARACENTESIS
When consenting a patient for a paracentesis, the general risks for any procedure should be discussed:
- Risk of bleeding: anytime a needle punctures the skin, there is a risk for bleeding. While the needle used for a paracentesis is small, and the needle will not travel too deep into the body, this risk still exists.
- Risk of infection: anytime the skin is penetrated their is a risk of introducing an infection into the body. It is possible from this procedure that the skin, the ascites fluid, or components of the abdomen to become infected.
- Risk of damage to adjacent structures: with any procedure, there is always a chance that there may be damage to structures that surround the area in which the procedure is being performed. For a paracentesis, structures that may be damaged are superficial structures such as blood vessels that travel through the skin/abdominal wall, as well as intra-abdominal structures such as the bowels.
While these general risks exist, it is useful to contextualize what is being done to minimize the risk to the patient:
- Minimizing risk of bleeding: the patient’s bleeding risk is evaluated through a combination of a chart review, reviewing the patient history, evaluating the patient’s labs, and then also using a small needle with the assistance of image guidance to avoid large blood vessels.
- Minimizing the risk of infection: the procedural field will prepped with antiseptic and then draped in a sterile fashion to limit the chance that an infection will be introduced through the needle puncture site. During the procedure only sterile equipment and sterile technique will be used to further minimize this risk.
- Minimizing risk to adjacent structures: typically the paracentesis will be done with image guidance which will help idenifty adjacent strcutres and make it easier to avoid damaging them during the course of the procedure.
SPECIFIC RISKS TO DISCUSS FOR A PARACENTESIS
While the above risks are important to discuss when consenting a patient for a paracentesis, there are other risks that are more specific to the paracentesis procedure which should be discussed as well:
- Abdominal wall bruising/hematoma: some patients may develop bruising over the area of the paracentesis, or even a abdominal wall hematoma if associated bleeding is large enough.
- Persistent leakage of ascites fluid: some patients will have ascites fluid leak through their paracentesis site after the procedure has been conducted.
- Hypotension/circulatory dysfunction: some patients may become hypotensive and/or may develop some component of circulatory dysfunction as a result of volume shifts during the procedure.
While these risks exist, it is useful to contextualize with is being done to minimize the risk to the patient:
- Abdominal wall bruising/hematoma: care is taken to minimize bleeding risk as described above.
- Persistent leakage of ascites fluid: compressive dressings can be applied at the end of the case to contain any possible leaks until the skin heals. In certain cases skin glue can be used to seal the hole responsible for leaking, or a collecting bag may be applied.
- Hypotension/circulatory dysfunction: patients who become hypotensive will have the procedure stopped and will be resuscitated with albumin containing fluids as needed. If there is concern that patients will have circulatory dysfunction then patients will be given albumin containing fluids prophylactically (in the case of a larger volume paracentesis).
Page Updated: 09.08.2019