Incidence and risks of complication following 2,230 image-guided abdominal paracentesis

Abstract

Background: Routine use of ultrasound (US) guidance for abdominal paracentesis has not gained consensus due to a lack of clinical data demonstrating greater safety relative to paracentesis performed without bedside imaging.While many studies have described complication rates after blind paracentesis, there have been limited reports describing incidence and risk factors for major complications following image-guided abdominal paracentesis in large cohorts.Here, we report an institutional experience of a large number of US-guided abdominal paracentesis performed.Methods: For each paracentesis, we obtained relevant clinical, laboratory, and procedural variables to identify factors associated with major complications.Data was collected for 389 consecutive patients undergoing 2,230 abdominal paracentesis.Results: Overall, 35 subjects experienced 56 major complications, representing a 2.5% complication rate.Of note, the complication rates for pain, bleeding, and perforation were 0.13%, 0.18%, and 0%, respectively.Mortality following paracentesis was recorded in three cases or 0.13% of procedures.Greater serum sodium levels and larger diameter catheters were associated with a lower risk of complication, while ascites related to malignancy were associated with a greater risk of complication.Indicators of coagulopathy, such as low platelet count or prolonged prothrombin time, did not correlate with risk of complication.Conclusion: Our cohort's relatively low complication rate supports that US-guided paracentesis is safe and well-tolerated.The administration of coagulation factors or blood products to prevent US-guided paracentesis-related complications is unlikely to be beneficial.

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