Ascites is the accumulation of water in the abdomen, commonly due to leakage from the liver’s portal vein. Ascites adds significant body weight as the water accumulates, making movement more difficult. It also pushes on internal organs, and this compression can affect ability to breath, eat, and other body activities.
In March of 2021 I visited the Stanford ER after several months of getting progressively sicker. By the time I made this critical step, my abdomen was extended like I was pregnant (perfectly matching the pictures for advanced Ascites) and one of the first ER procedures done to me was to drain that excess fluid in my abdomen with a Paracentisis (greek for 'peircing').
Paracentisis is done partially to relieve a symptom (the excess water) and also to test whether there are any bacteria in the fluid. It is a conceptually simply procedure: jab a long needle into a pocket of water in the abdomen and pull the water out.
My first paracentisis may have gone well in terms of diagnostics: they verified I had no bacteria in the abdomenal fluid. In most other ways, it went pretty badly. The rotating doctor and their assistant both seemed to have limited experience with the procedure.
The needle was inserted successfully in a pocket of water that was found through using an ultrasound machine. This may be easy given how full of water I was, but it can be difficult if there are fewer or smaller pockets. But withdrawing any water apparently was not working.
There are 'light vacuum' liter bottles that can be attached to the paracentisis needle and ideally they just fill up. That did not happen.
After trying a couple bottles without success, and with some amount of water going onto me, my clothes, the bed, and possibly the floor, they changed to using a syringe to pull water out. Eventually they got some amount of water into bottles, which didn't have a visible impact to my abdomenal area. But it was enough for the diagnostics and I was given standard hospital wear to replace my soaked clothes.
When admitted to Stanford from the ER, I was put into the M5 ward that specializes in liver and kidney disease, treatment, and transplants. There I met a nurse that specializes in paracentisis and saw a much more effective and less messy version of it.
An ultrasound is done to find a pocket, a long needle is inserted into the pocket, and a tube extends off the end of the needle. The nurse simply attached a bottle to the tube and it filled up. After four more bottles, I was ten pounds liter. The nurse did explain that some of the bottles don't work properly, so this could have been the issue in the ER. After removing five liters, she removed the slender needle and put surgical glue over the whole.
The benefit of losing ten pounds of weight massively outweighed the very minor discomfort of the procedure. It is a bit more painful and invasive than a blood draw, but not by much.
