Background: The American Board of Internal Medicine suggests residents participate in a minimum of five abdominal paracentesis (AP), central venous catheter (CVC) placements, and lumbar punctures to ensure “adequate knowledge and understanding” of procedures performed by practicing internists. Competency in these procedures is poorly defined and difficult to assess. To address the need for well-supervised, [...]

Background: Large volume paracentesis is commonly performed in patients with refractory ascites but can induce hypotension and kidney injury. There is evidence that administering albumin at 6-8 grams per liter (g/L) of ascites removed during or after paracentesis can reduce these adverse events. Current guidelines recommend this practice when >2 liters are removed in high-risk [...]

Background: Patients with ascites due to cirrhosis frequently have some degree of thrombocytopenia and prolongation of prothrombin time. However, major bleeding rates from paracentesis are reported to be less than 1% without use of any prophylactic blood products (plasma and/or platlets) and the mortality rate is 0.016%. Consequently, practice guidelines recommend against prophylactic transfusion of [...]

Background: Paracenteses are performed frequently at bedside by hospitalists, intensivists, gastroenterologists and emergency medicine providers. They are considered a core procedure that historically have been performed “blind” with only the use of percussion to determine the presence of fluid. With the rise of ultrasound based procedures the majority of paracenteses are now performed with ultrasound [...]