Therapeutic Paracentesis

Nursing Knowledge

Therapeutic Paracentesis

Paracentesis is an important diagnostic or therapeutic procedure removing fluid from the peritoneal cavity with a needle. The reason for the procedure can be to diagnose the cause of ascites, or to relieve symptoms from large amounts of fluid that can not be solved with medication and dietary adjustments. Key points are providing emotional support and reassurance for clients before an invasive procedure, and to closely monitor vital signs during and after.

Last updated: December 15, 2025

What is therapeutic paracentesis?

Definition

Paracentesis is an invasive procedure in which a large-bore needle is inserted into the abdomen to drain fluid from the peritoneum through a drainage catheter into a container.

If done for diagnostic purposes, a small amount of fluid is removed for testing. Removing large volumes of fluid via paracentesis is an important treatment measure when ascites does not resolve with medication and dietary changes.

Note: The suffix -esis always indicates that the term means something related to shifting fluids.

Indications for therapeutic paracentesis

Ascites, the accumulation of fluid in the peritoneum, is a key complication of liver cirrhosis and a typical indication for therapeutic paracentesis. The first line of treatment for ascites is based on a low-sodium diet and diuretic treatment. If the drug therapy and dietary restriction are no longer effective, paracentesis is the next step.

Nursing tasks around therapeutic paracentesis

Preparation and monitoring

Nursing tasks involve preparing the client for the procedure, and monitoring the client’s safety during and after the procedure.

Provide emotional support and reassurance to clients, as many perceive the invasiveness of the procedure as worrisome.
Immediately before the procedure, have the client empty the bladder to minimize the risk of nicking the bladder.
Clients are at increased risk for electrolyte imbalances and hypovolemia and require close monitoring.

During and after the procedure

Note: Drain fluid slowly to minimize the client’s risk of circulatory collapse.

The procedure can take minutes up to a few hours depending on the amount of fluid removed, and how stable the patient is.

After the procedure:

Place the client in high-Fowler’s position or supine turned toward the side.
Monitor the client’s vital signs and notify the provider of changes:
- If there is internal leaking, the blood pressure rises and the heart rate increases.
- If the client reports dizziness, the increased heart rate and decreased blood pressure points to hypotension.
Watch the dressing for signs of leaking ascitic fluid or bleeding.
Notify the provider for the following:
- Client reports increased pain or shortness of breath
- Drainage noted on dressing

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