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Patient Safety Forum |

Making Paracentesis SaferUltrasonography Use in Paracentesis: A Proposal for the Use of Bedside Abdominal and Vascular Ultrasonography to Prevent a Fatal Complication

Hiroshi Sekiguchi, MD; Jun Suzuki; Craig E. Daniels, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.

Correspondence to: Hiroshi Sekiguchi, MD, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: sekiguchi.hiroshi@mayo.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(4):1136-1139. doi:10.1378/chest.12-0871
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Paracentesis has been considered a relatively safe procedure; however, hemorrhagic complications do occur and can be fatal, especially in the context of coagulopathy. We describe the case of a 47-year-old man with coagulopathy secondary to end-stage liver disease, whose hospital course was complicated by paracentesis-related hemoperitoneum leading to abdominal compartment syndrome. Emergent laparotomy revealed left inferior epigastric artery laceration caused by paracentesis. Despite operative control of bleeding, postoperatively, the patient developed severe metabolic acidosis, disseminated intravascular coagulation, and ultimately died from complications of hemorrhagic shock. Understanding key anatomic structures is essential for patient safety in the setting of paracentesis. While recognizing the lack of clinical studies demonstrating the effectiveness of ultrasonography use in paracentesis, we discuss the benefit of bedside abdominal ultrasonography to locate ascites and avoid intraabdominal structures, as well as vascular ultrasonography, during needle insertion to avoid abdominal wall vessels.

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