Paracentesis: datos sobre la correcta utilización / Paracentesis, Appropriate Technique and Clinical Application

La paracentesis es un procedimiento con fines diagnósticos en pacientes con ascitis de novo. Permite detectar la presencia de infección en pacientes con ascitis de larga data. En casos de ascitis a tensión, ascitis refractaria y disnea por restricción es ampliamente utilizada como terapia. El conocimiento general de este procedimiento y de los pormenores de su técnica son de gran importancia, ya que su utilización viene en aumento en los servicios de urgencias, hospitalización general e incluso, en la unidad de cuidados intensivos. Teniendo en cuenta lo anterior, se hace hincapié en la correcta utilización de esta técnica por parte del personal médico. Métodos: Se realizó una búsqueda de la literatura científica en las bases de datos Pubmed y SciELO de artículos con una estrategia definida, limitada a idiomas español e inglés, utilizando una combinación de términos libres y MeSH que incluyeron paracentesis, ascitis, cirrosis hepática y malignidad.

Paracentesis is a diagnostic procedure used in patients with new-onset ascites. It can detect the presence of infection in patients with longstanding ascites. In cases of tense ascites, refractory ascites or restriction dyspnea it is widely used for therapeutical purposes. General knowledge of this procedure is of great importance as well as a detailed understanding of the technique, because its use is increasing in the emergency department, general hospitalization, and even in the intensive care unit. Taking all this into consideration we aim to emphasize on the proper use of this technique by the medical staff.

Value of duplex ultrasound to investigate whether large volume paracentesis without infusions is safe, easy and economic in selected cirrhotic patients

In tense or refractory asciites, large volume paracentesis [LVP] combined with intravenous infusions has been suggested as the preferable treatment. Flow volume rate [FVR] of portal vein [PV] and Hepatic artery [HA] were measured before and one day after large volume paracentesis [L VP]. 58 cirrhotic patients with ascites were allocated into 2 groups; group [1]: 28 patients were not infused by isotonic fluids, group [2] 30 patients [divided into 3 equal subgroups 2a, 2b and 2c] were infused by different isotonic solutions as follow saline, hemaccel and human albumin respectively. FVR of PV in group 1, 2a, 2b and 2c before LVP were 1894.4+3.3, 1235.5+7.8, 1253.9+19 and 2172+4,2 ml/mm respectively and one day after LVP they were 2207+11,2, 1666+7.4, 1396+29.3 and 1835+8.7 ml/min respectively. FVR of HA in group 1, 2a, 2b and 2c before LVP were 222,7+3.2, 182.3+4.4, 286.4+5.9 and 238,8+4.1 ml/min respectively. FVR of HA in group If 2a, 2b and 2c after LVP were 541.7+4.2, 329.1+2.9, 289,7+1.7 and 284 4+4.2 ml/min respectively, We conclude that FVR was significantly increased after LVP in the majority of the patients; more in patients non infused as compared to infused patients provided we select probably our patients. LVP less than 5 liters without infusions in selected patients are effective, safe, easy and economic. This research was funded by Theodor Bilharz Research Institute [TBRI] and Egyptian Academy of Research and Technology