Paracentesis

Contraindications
Absolute contraindication
y

Acute abdomen that requires surgery

Relative contraindications
y

y y y y y

Severe thrombocytopenia (platelet count <20 X 103/ L), coagulopathy (international normalized ratio [INR] >2.0), or both o Patients with an INR greater than 2.0 should receive fresh frozen plasma (FFP) prior to the procedure. One strategy is to infuse one unit of fresh frozen plasma before the procedure and then perform the procedure while the second unit is infusing. 3 o Patients with platelet counts less than 20 X 10 / L should receive an infusion of platelets prior to performing the procedure. In patients without clinical evidence of active bleeding, routine labs such as prothrombin time (PT), activated partial thromboplastin time (aPTT), and platelet counts may not be needed prior to the procedure.5 In these patients, pretreatment with FFP, platelets, or both before the paracentesis is also probably not needed. A study of 608 patients (72% with alcohol-related liver disease) found a low overall rate of complications that required transfusions (0.2%) and a higher incidence of significant hemoglobin drop among those with severe renal failure (creatinine > 6 mg/dL). Pregnancy Distended urinary bladder Abdominal wall cellulitis Distended bowel Intra-abdominal adhesions

THORACENTESIS
Contraindications

1. 2.

Local skin infection over proposed site of thoracentesis Uncontrolled bleeding or clotting abnormality

Contraindications

y Local infection over proposed site of thoracentesis (e.g. cellulitis, herpes zoster). Select another entry site y Uncontrolled bleeding y Coagulopathy is a relative contraindication; some data suggest it is safe to perform thoracentesis in patients with mild PTT elevations (<1.5 times the upper limit of normal). The decision to use reversal agents in patients with severe coagulopathy or platelet transfusion in those with clinically significant thrombocytopenia must be made on an individual basis y Caution must be exerted when performing thoracentesis in mechanically ventilated patients. The positive pressure of the ventilator may expand the lung to greater than normal volumes, increasing the potential risk of pneumothorax. Ultrasound-guided thoracentesis is recommended in this situation y Defer thoracentesis in patients with severe hemodynamic or respiratory compromise until the underlying condition is stabilized