A recent study of nearly 5,000 ultrasound-guided paracenteses concluded that the risk of major bleeding can be reduced if a two probe technique is used compared with a single probe approach. The traditional single probe approach to ultrasound-guided paracentesis utilizes a phased array probe to identify the optimal needle insertion site which is then marked. The abdominal wall is then prepped and draped and a paracentesis is performed using standard technique and either an angiocatheter, a Caldwell needle or a paracentesis kit to enter the peritoneal cavity.
A new study examined 4,777 consecutive ultrasound-guided paracenteses from the procedures service at Cedars-Sinai Medical Center in Los Angeles, California. They found that the addition of abdominal wall imaging using a linear array probe to locate the abdominal wall vessels and avoid these if identified. The results showed that the incidence of minor bleeding was similar between the one probe and two probe techniques. However, major bleeding was lower in the post-intervention or two probe group (3 [0.3%], n = 1000 vs 4 [0.08%], n =4777; P = 0.07).
The incidence of major bleeding was only 0.3% with traditional ultrasound-guided paracentesis, but decreased to almost 0% with a two probe technique.