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PRACTICE POINT
www.nature.com/clinicalpractice/gasthep
Original article Sakai H et al. (2005) Choosing the location for non-image guided abdominal paracentesis. Liver Int 25: 984986
Where is the optimal location for paracentesis?
GLOSSARYMODEL FOR END-STAGE
LIVER DISEASE
Liver disease severity scoring system (640) based on values of bilirubin, creatinine and international normalized ratio; it is often used for the allocation of transplant livers
KEYWORDS ascites, cirrhosis, obesity, paracentesis, site
BACKGROUND
Paracentesis involves the removal of ascitic fluid from the peritoneal cavity using a needle. The ideal location for performing paracentesis has not yet been established. In obese patients with cirrhosis and ascites, the procedure can be more difficult, owing to incomplete penetration of the peritoneal cavity by the needle because of increased abdominal girth.
OBJECTIVES
To identify the optimal site for paracentesis in patients with cirrhosis and ascites.
DESIGN AND INTERVENTION
Consecutive patients with cirrhosis and ascites confirmed by ultrasound were included in this prospective study. Patients with incomplete medical data were excluded. The depth of ascites and the thickness of the abdominal wall were ascertained by ultrasound at two locations on each patient: left lower quadrant (LLQ) and infraumbilical midline (ML). The ML site was defined as two fingerbreadths inferior to the umbilicas and the LLQ site was defined as two fingerbreadths cephalad and two fingerbreadths medial to the left anterior superior iliac spine. Patients were positioned in the supine and left lateral oblique position during measurement of the depth of ascites at the LLQ and ML sites, and were also positioned in the left lateral position during measurement at the ML site. All patients were supine during measurement of abdominal wall thickness at
both the LLQ and ML site. The presence or absence of pitted wall edema was recorded at the time of ultrasound. BMI was calculated...