Paracentesis

Procedures & Monitoring · ICU Decoded chapter 78 · Locked — free with a referral

By Dr Javed Akhtar · Last reviewed 3 October 2026

Cited to AASLD ascites guidance.

Key points

Tap ALL new ascites and any admitted ascites diagnostically, screening for SBP with PMN ≥250.
Use ultrasound guidance at an LLQ/lateral site; send cell count, albumin (SAAG), protein, and culture (inoculate bottles at the bedside).
LVP >5 L: give albumin 6–8 g per liter removed.
Rare complications: bleeding, persistent leak (Z-track), infection.

Investigations

First tests: Full blood count, Sodium, potassium, bicarbonate, urea and creatinine, Liver biochemistry, PT/INR.

Only if indicated: Diagnostic ascitic fluid cell count/differential and culture, Ascitic albumin/protein with paired serum albumin, Urinalysis and microscopy, Blood cultures.

Repeat monitoring: Sodium, potassium, bicarbonate, urea and creatinine.

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Why and when to send each test

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