Ascitic Drain Insertion Consent 💉
Consent guide for ascitic drain insertion (paracentesis). Procedure explanation, risks, benefits, SAAG calculator, and patient information for obtaining informed 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).
✅ Indications
- 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
🔍 Procedure Overview
- 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.
⚠️ Risks & 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).
❓ Common Patient Questions
- 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).
📝 Additional Notes
- 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.
💊 Special Considerations
- 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.
📎 External Resources
SAAG Calculator
Serum-Ascites Albumin Gradient