Ascitic Drain Insertion Consent 💉

📌 Procedure/Investigation

Ascitic drain insertion (therapeutic paracentesis) is a procedure where a needle or catheter is inserted into the peritoneal cavity to remove ascitic fluid for symptom relief or diagnosis.
It may be diagnostic (sample sent to lab for analysis) or therapeutic (to relieve discomfort, breathlessness, or abdominal distension).

Relief of symptomatic ascites (abdominal distension, discomfort, breathlessness)
Diagnosis of ascites (e.g. to determine SAAG, cell count, culture, cytology)
Suspected spontaneous bacterial peritonitis (SBP)
Large volume ascites causing respiratory compromise

You will usually lie flat or slightly tilted on your side.
The skin is cleaned and local anaesthetic is applied.
Ultrasound is typically used to guide needle/catheter insertion into the peritoneal cavity.
Fluid is drained using a syringe or closed drainage system (often several litres can be safely removed).
A dressing is applied afterwards, and you may have an ultrasound to check for complications.

Common: Discomfort at insertion site, transient hypotension (especially with large volume drainage).
Uncommon: Infection (including peritonitis), bleeding, leakage from puncture site.
Occasional: Bowel perforation, failure to obtain fluid, vasovagal reaction.
Rare: Significant bleeding requiring intervention, damage to intra-abdominal organs, renal dysfunction post-drainage.
Very rare: Death from complications (extremely rare).

Will it be painful? → You may feel pressure or stinging from local anaesthetic, but pain is usually minimal.
Can I eat or drink beforehand? → Usually yes, unless otherwise advised.
How long does it take? → Around 15–45 minutes, depending on volume drained.
How much fluid will be removed? → Typically 2–5 litres, but depends on your condition and clinical need.
Can I go home after? → Often yes, but you may be monitored briefly for complications (especially hypotension).
Will I need it again? → Possibly, depending on the underlying cause of ascites (e.g. liver disease, malignancy).

A trained clinician should take consent and perform the procedure.
Ultrasound guidance should be used when available to reduce complications.
Anticoagulation and clotting status should be reviewed prior (INR, platelets).
Large volume paracentesis (>5L) may require albumin replacement to prevent circulatory dysfunction.
Consent should include discussion of benefits, risks, and alternatives (e.g. diuretics, observation, or repeated drainage).
Monitor for signs of infection, bleeding, or hypotension post-procedure.

Check coagulation profile (INR, platelets) before procedure.
Consider prophylactic antibiotics if at risk of SBP.
Monitor blood pressure during and after large volume drainage.
Send ascitic fluid for MC&S, cell count, SAAG, and cytology as clinically indicated.
Ensure sterile technique to reduce infection risk.

Serum-Ascites Albumin Gradient

Serum Albumin (g/L)

Ascites Albumin (g/L)