The most common systemic complication is hemodynamic compromise due to overzealous removal of ascitic fluid. While the evidence is controversial, there are documented reports of severe hypotension resulting from large volume fluid removal.

Prevention:

The hypotension often occurs with little or no warning during or immediately following the procedure. As such, most sources recommend that a maximum of 4-5 L be removed at a time.

Management:

• Judicious IV saline bolus
• Trendelenburg position
• Colloid infusion (typically albumin) is an option for refractory conditions, but is usually reserved for cases in which greater than 5L of ascitic fluid is removed