Abdominal paracentesis (ascitic drain): why it is done, what happens and aftercare

Ascites is the medical word for too much fluid in the abdomen. The Worcestershire leaflet explains that the peritoneum, the thin lining inside the abdominal cavity, normally produces a small amount of fluid so the organs can move against each other smoothly. Certain illnesses upset the balance between production and reabsorption, so that fluid builds up.

Abdominal paracentesis, also called an ascitic drain or abdominal drain procedure, is the procedure to remove that fluid. A plastic tube is inserted into the peritoneal cavity and is attached to a bag on the outside that collects the fluid, according to the Dorset leaflet.

Paracentesis relieves the pressure of the fluid. It does not treat the underlying illness, which is why people who need repeated drains are usually under a liver or other specialist team who manage the cause.

The Dorset leaflet says liver cirrhosis is the most common reason for build-up of fluid in the abdomen. Your specialist will explain what is behind the fluid in your own case.

The Worcestershire leaflet lists the symptoms: a swollen, bigger abdomen, abdominal pain, shortness of breath, nausea and vomiting from the increasing pressure of fluid, and also indigestion, poor appetite, reduced mobility and tiredness.

Because those symptoms can be significant, relieving them is the intended benefit. Dorset says that inserting a drain will relieve discomfort and can improve mobility and appetite.

Dorset says that sometimes medication alone does not get rid of the fluid, so it builds up in the abdomen. In that situation a drain is a way to remove it directly.

Fluid may also be sampled. Dorset says some of the fluid is sent to the laboratory for analysis, and the team will explain what it shows.

You will usually need a blood test beforehand. The Worcestershire leaflet says this is to check your blood clotting levels, and that you can eat and drink normally beforehand, with routine medication taken with sips of water. Dorset describes having a blood test and a cannula placed in a vein in your arm or hand, and waiting until results are available before the procedure goes ahead.

Blood-thinning and antiplatelet medicines need individual advice. The Worcestershire leaflet gives specific instructions for aspirin, clopidogrel, warfarin and newer anticoagulants, and says these should only be stopped after discussion with the referring clinician. Never stop a medicine on your own: tell the team what you take and follow their instructions.

You will be asked to empty your bladder before the procedure, according to Dorset. Bring your usual medicines, since Worcestershire says you will usually be asked to continue them during your stay. If you feel unwell with a cough, a cold or another illness on the day, tell the team, because the procedure may need to be delayed.

You lie on your back on a bed or trolley. Both leaflets describe the use of an ultrasound machine to assess the fluid and choose the best place for the drain, which Dorset says is usually either the left or right side of the lower abdomen. The skin is cleaned with antiseptic and a local anaesthetic is injected, which can sting briefly before the area goes numb. You might feel some pushing as the drain goes in.

Once the drain is in, it is secured with a dressing and attached to a drainage bag. Nurses monitor how much fluid drains, and your blood pressure and other observations are checked frequently, because a fall in blood pressure is a recognised effect when a lot of fluid is removed. Worcestershire advises drinking plenty during draining to help avoid low blood pressure.

Dorset says you will receive albumin through your cannula after every three litres drained, and that the drain comes out after the advised amount, usually 10 to 12 litres, or after six hours, whichever comes first. The drain is then gently pulled out and a dressing is put over the site. Worcestershire says most people go home once the fluid has finished draining provided they feel well.

Both leaflets describe paracentesis as safe, with a small risk of complications. Dorset lists bleeding, infection and low blood pressure as possible, along with mild pain and leakage from the drain site after removal. Very rarely there is injury to organs in the abdomen, including the bowel, liver and bladder, which the use of ultrasound minimises. The procedure can also fail, in which case alternatives are offered.

The Worcestershire leaflet adds that the drain may get blocked, so you might be asked to change position or sit up, and occasionally the tube has to be changed. Some people feel tired. Possible effects include abdominal pain, bleeding from the insertion site, and leakage, and if leakage continues 48 to 72 hours after removal the team should be told, as a small stitch may be needed.

Keep the dressing and the site dry for at least 48 hours after the drain is removed, according to Worcestershire, which may mean washing rather than showering or bathing. Recovery varies; it can take one to two days, and the leaflet advises resting for the remainder of the day.

Dorset says it may take a few days for the wound to heal and that simple painkillers may be needed if there is pain around the site. Fluid often collects again; it says this can be managed with absorbent dressings and that you should contact the liver team if symptoms return.

Worcestershire advises contacting your consultant or attending the nearest A&E (not minor injuries) if you have excessive bleeding from the drain site, excessive sweating or shivering, generally feel unwell or have increasing pain. If your symptoms or condition worsen, call your GP, NHS 111 or 999 as appropriate.

On the NHS, an ascitic drain is usually done by a gastroenterology or liver team in a medical day unit, or by a radiologist in the imaging department, as the two leaflets illustrate. Where the cause is cirrhosis, the same team will review medicines and follow-up.

Private hospitals can also perform paracentesis, but because ascites is usually a sign of a significant underlying condition, continuity of specialist care matters more than where the drain is inserted. Ask which team will review the fluid results and who you should call if the swelling returns.