Diagnostic Paracentesis in Cirrhotic Ascites From Core IM And The American Thoracic Society

This post covers, from CoreIM and the American Thoracic Society YouTube Channel:

Here are excerpts from Mind The Gap on Admission Paracentesis, Part 1:

Show Notes

  • AASLD and European Association for the Study of the Liver guidelines recommend patients with cirrhosis and ascites admitted to the hospital should undergo a diagnostic abdominal paracentesis.
  • In a prospective observational trial, physician clinical impression had a sensitivity of 76% and specificity of 34% for spontaneous bacterial peritonitis on admission
    • Faculty tended to be more sensitive than residents, but not statistically significant.
    • Don’t forget about asymptomatic SBP!
  • Delayed paracentesis is associated with increased in-hospital mortality in patients with SBP comparing early paracentesis within 12 hours of admission vs. delayed between 12- 72 hours from admission.
    • This corresponded to an increase in mortality of 3.3% for every hour delayed.

Here are excerpts from Mind the Gap on Abdominal Paracentesis, Part 2:

Take Away Points

  • It has been shown in cirrhotic with INRs greater than 1.5 and platelets less than 50, there were minimal complication rates after paracentesis.
  • Platelet transfusion prior to paracentesis is grade III recommendation. It was neither useful nor effective, and it can even be harmful.
  • General internists had the similar safety outcomes as IR specialists and gave fewer platelets and FFP transfusions.
  • Sending paracentesis fluid in blood culture bottles increased yield.

The YouTube video,  Ultrasound for Paracentesis — BAVLS:, from the American Thoracic Society should be watched in its entirety as there are many valuable points. Ultrasound should be used if available as it makes paracentesis safer.


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