Paracentesis ascites

A paracentesis procedure is often performed in the Emergency Department to rule a patient out for spontaneous bacterial peritonitis (SBP).

  • Do you check coagulation studies before performing the procedure?
  • How comfortable do you feel that the patient has SBP with an ascites WBC > 500 cells/microliter or ascites PMN > 250 cells/microliter?

This installment of the Paucis Verbis (In a Few Words) e-card series provides an evidence-based review of the literature on topics related to the paracentesis procedure. Especially helpful is the pooled data of likelihood ratios. Like most everything in medicine, a lab test should be used in conjunction with your pretest probability in clinical decision making, and LR’s help with with this.

PV Card: Ascites and Paracentesis

Adapted from [1] Go to ALiEM (PV) Cards for more resources.


  1. Wilkerson RG, Sinert R. The Use of Paracentesis in the Assessment of the Patient With Ascites. Annals of Emergency Medicine. 2009;54(3):465-468. doi: 10.1016/j.annemergmed.2008.09.005
Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at Bio:
Michelle Lin, MD