Z tracking for paracentesis

Z-tracking is a way to minimize fluid leakage after performing a paracentesis. The skin is slowly pulled down while the needle is advanced in 5 mm increments, aspirating as you go. If it is a therapeutic paracentesis, use a large bore needle (14) to reduce the amount of time it takes to drain.

Indications for paracentesis

  • New onset ascites
  • Hospitalization of a patient with ascites
  • Clinical deterioration of an inpatient or outpatient with ascites
    • Fever
    • Abdominal pain
    • Abdominal tenderness
    • Hepatic encephalopathy
    • Peripheral leukocytosis
    • Deterioration in renal function
    • Acidosis

Routine tests

  • Cell count and differential
  • Albumin concentration (you then compare this to serum albumin)
  • Total protein concentration
  • Culture


DIC, primary fibrinolysis

serum to aspires gradient (SAAG)

Used to identify the presence of portal hypertension

SAAG = Serum albumin – Ascites albumin

≥11 g/L: portal hypertension
<11 g/L: not portal hypertension
If heart failure is the cause, the gradient can be narrowed by diuresis, but in cirrhosis the gradient does not change unless the portal pressure drops significantly

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  1. Pingback: Paracentesis: Anatomic Landmarks | Sketchy Medicine

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