Risk of Bleeding with a Midline vs. Lateral Approach to Paracentesis

Paracentesis is traditionally approached through the lateral lower quadrant to reduce the risk of injuring the liver, spleen, and inferior epigastric artery. Using a midline approach instead — 2 to 3 cm below the umbilicus via the relatively avascular linea alba — may lead to fewer bleeding complications, but until now, no direct comparison has been made.

In this single-center study, researchers retrospectively reviewed 4500 ultrasound-guided paracenteses conducted among 1800 hospitalized patients; 5% of the procedures were completed with a midline approach, and the rest were lateral.