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Large Volume Paracentesis

Paracentesis is a procedure performed to remove new ascites in the context of fever, abdominal pain, worsening renal function, and acidosis usually in patients with decompensated cirrhosis. I use a standard paracentesis kit and a “Z-tracking” approach with my needle so the soft tissue and abdominal wall “seal off” the track I make with my paracentesis catheter.

As fluid is removed from the peritoneal cavity, the splanchnic vascular bed is mechanically decompressed leading to vasodilation and hypotension. The resulting paracentesis-induced circulatory dysfunction (PICD) will, in turn, activate the renal-angiotensin-aldosterone pathway to increase free water and sodium retention and can lead to increased morbidity and mortality.

To mitigate PICD, albumin is routinely utilized as a volume expander to maintain hemodynamics with a decent amount of literature (PubMed “albumin paracentesis”) supporting this practice. I’ll usually give 6 – 8 grams of 25% albumin for each liter I remove with a touch of norepinephrine for vasoconstriction.

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