Slide 1: Why use POCUS for paracentesis? Paracentesis is generally a very safe procedure. However, the use of ultrasound is recommended to reduce the risk of bleeding, and to increase the likelihood of finding a large fluid pocket. Throwback! The low frequency curvilinear probe is excellent for paracentesis given the depth of tissue penetration it offers.

Slide 2: Studies have found that ultrasound-guided paracentesis is more likely to be successful and is less likely to cause complications. A study of emergency medicine residents found that ultrasound-guided paracentesis had a higher success rate (95% versus 61%, p = 0.0003) compared with landmark guided procedures. Ultrasound-guided paracentesis had a lower rate of adverse events (such as infection, hematoma, and seroma) compared with landmark technique (1.4% versus 4.7%, p = 0.01). Graphic showing that ultrasound-guided paracentesis had a higher success rate and fewer complications than landmark guided paracentesis.

Slide 3: Ultrasound can be used in two ways to guide paracentesis. 1. Statistically. A non-sterile ultrasound probe is used to mark a fluid pocket and epigastric vessels prior to performing the sterile procedure. 2. Dynamically. An ultrasound probe is placed in a sterile sleeve and used in real time to guide the sterile procedure. Dynamic guidance is an advanced technique recommended for skilled users trying to sample smaller pockets. In future bytes, we’ll explore two POCUS micro-skills to perform paracentesis safer and with higher diagnostic yield. 1. Identify and mark a large fluid pocket. 2. Find and mark the epigastric vessels.