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

Contraindications

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