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The key steps to performing a paracentesis. Presented by Drs. Jess Mason and Andres Anaya at UCSF Fresno.

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Stuart W. -

Does anyone who does US guided paracentesis have comments in regards to the apparent consistency of the needle insertion points in relation to the traditional surface anatomy landmarks. My experience suggest US rarely alters position but maybe changes the side of approach. Has there been any correlation studies done?

Jess Mason -

Sure, it can change the side of the approach. I ultrasound is a great tool because sometimes there's NOT a safe pocket of fluid in a spot you thought there would be. The Nazeer study cited below compared blind to ultrasound guided paracentesis. There was a higher failure rate in the blind group (39% vs 5% in the ultrasound guided group). Ultrasound also allows you to abandon the procedure before it even begins if not enough fluid is seen on ultrasound, and this happened frequently in the study as well. Another study (Mercaldi) found lower risk of bleeding if ultrasound is used.

Nazeer SR, Dewbre H, et al. Ultrasound-assisted paracentesis performed by emergency physicians vs the traditional technique: a prospective, randomized study. The American journal of emergency medicine. 2005 May 31;23(3):363-7.

Mercaldi CJ, Lanes SF. Ultrasound guidance decreases complications and improves the cost of care among patients undergoing thoracentesis and paracentesis. CHEST Journal. 2013 Feb 1;143(2):532-8.

steven c. -

i noticed no traction applied to the skin (ztrack). In your collective experiences do you have more leaking without z tracking or do you think its a non issue?

Jess Mason -

I think this is one of those things that is classically taught but I'm unsure how practical it actually is. Does it really prevent leaking of ascites fluid? Not sure. Can't hurt to do it but who knows if it has any benefit.

Aaron K. -

Love the suction technique to make a mark!

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