Systemic

• Given the predominance of alcohol-related cirrhotic liver disease as the cause for ascites, as many as two-thirds to three-quarters of patients who undergo paracentesis will have a coagulopathy (e.g. elevated prothrombin time). However, less than 1% of patients subjected to paracentesis will have transfusion-requiring abdominal hematomas. Thus, prophylactic administration of fresh frozen plasma or platelets is reserved for patients with clinically evident fibrinolysis and disseminated intravascular coagulation.
• Note: DIC or evidence of fibrinolysis is considered by some to be an absolute contraindication to paracentesis

Anatomic

Structural impediments to the safe introduction of a paracentesis needle can include the bladder, bowel, and pregnant uterus.

• Bladder- normally safe in pelvis, however neuropathically distended bladders (by pharmacological agents or medical conditions) should be emptied by voiding or catheterization prior to paracentesis to avoid puncture
• Bowel- intestines typically float in ascitic fluid and will move safely out of the way of a slowly advancing needle. Even if penetrated by an 18 to 22 gauge needle, intestinal contents will not leak unless intraluminal pressure exceeds normal conditions by 5 to 10 fold greater than normal. Thus, ultrasound guidance may be indicated in cases of suspected adhesions or bowel obstruction
• In the second and third trimester of pregnancy, an open supraumbilical or ultrasound guided approach is preferable
• In all patients, areas with evidence of abdominal hematoma, engorged veins, or superficial infections should be strictly avoided