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Laparocentesis
Last reviewed: 06.07.2025
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[ Technique of laparocentesis
Before the procedure, a complete blood count, platelet count, and coagulation status should be performed. After emptying the bladder, the patient sits upright in bed, leaning back at 45°. In patients with obvious and diagnosed ascites, the puncture site is located in the midline between the umbilicus and the pubic bone and is treated with an antiseptic and alcohol. In patients with moderate ascites, the exact location of the ascitic fluid is identified by abdominal ultrasound. Under sterile conditions, the puncture site is anesthetized to the peritoneum with 1% xycaine. For diagnostic laparocentesis, an 18-gauge needle attached to a syringe (50 ml) is inserted through the peritoneum (usually producing a characteristic popping sound). The fluid is effortlessly drawn into the syringe and sent to the laboratory for cell count, protein or amylase content, cytology, or bacteriological culture. For therapeutic (large volume) laparocentesis, a 14-gauge hollow needle is used, connected to a vacuum aspiration system, which is necessary for the evacuation of up to 8 L of ascitic fluid. Post-manipulation hypotension caused by fluid redistribution is rare in the presence of interstitial edema.
Laparocentesis: contraindications
Absolute contraindications to laparocentesis include severe, incurable blood clotting disorders; intestinal obstruction; infection of the abdominal wall. Difficult contact with the patient, scars from surgical interventions in the puncture area and severe portal hypertension with a pronounced collateral venous network on the abdomen are relative contraindications.