Have you just been told that you have unwanted fluid build-up in your abdomen and you are going to have an ascitic (paracentesis) drain inserted in your stomach to help drain the fluid out.
Are you wondering how the procedure is done and what to expect? In this article I will answer the most frequently asked questions you have about ascitic drains.
I rely on my experience as an interventional radiographer who assists radiologists every day during these procedures and also medical studies on the subject matter.
Happy reading!😀and feel free to ask questions in the comments or share your own experience.🙏
Last updated: sept, 2025. Written by Juliet Semakula, a diagnostic radiographer.
| Summary: Paracentesis or ascetic drain can be a temporary or long-term solution to relieve symptoms like build-up fluid, pain and breathing difficulties caused by ascites. The removed fluid can also be sent for diagnostic tests to help find out what is really causing the ascites. |
▶️What is the difference between ascites and ascitic drain?
Ascites is the medical term for a build-up of fluid in the abdomen.
So, for the build-up fluid to be removed from your body (abdomen) is what we call ascitic drain or paracentesis. This is normally the first treatment to help you feel better.
I have seen patients start feeling much better as soon as fluid starts flowing out after the drain has been inserted.
▶️Is having Ascites a common thing?
Yes, you should not feel alone if you have just been diagnosed with ascites. The truth is I see patients every week who come for ascites drains because of ascites.
So, it is very common and in some research studies, it is estimated that the majority (75%) of patients who present with ascites have underlying cirrhosis, with the remainder being due to malignancy (10%), heart failure (3%), tuberculosis (2%), pancreatitis (1%), and other rare causes (Moore,2006)
So, if you have been diagnosed with the condition, ascitic drains are common procedures done to help relieve any symptoms you may be facing.
▶️What is the difference between abdominal paracentesis and ascitic drain?
When you are diagnosed with ascites, your medical report may state that you need an ascitic or paracentesis drain, these two terms mean the same thing.
So, for the build-up fluid to be removed from your body (abdomen) is what we call ascitic drain or paracentesis. This is normally the first treatment to help you feel better.
Both Abdominal paracentesis and Ascites are medical terms for the procedure of inserting a drain to remove excess abdominal fluid (ascites), making it essentially the same thing.
Both terms refer to the process of inserting a tube or needle into the abdominal cavity to drain accumulated fluid, which is a common treatment for discomfort and pressure caused by ascites
Having a small amount of fluid within the abdominal cavity is normally not unusual and this is being continuously created and absorbed in our body.
But when fluid builds up, then this can become ascites when there is a disruption to the balance of production and removal, so that the amount of fluid within the abdomen builds up.
▶️Why would you need an ascitic drain?
As we have seen, ascites is the removal of excess fluid from the abdomen.
Usually, patients who come for these kinds of drains, they normally have the following symptoms caused by excess fluid.
🟣Abdominal pain
🟣Abdominal Swelling
🟣Shortness of breath sometimes
🟣Infection
The main purpose of the procedure is to relieve all the symptoms you may be experiencing.
The main reason it is often recommended is when other treatment options such as water tablets(diuretics) are not sufficient to manage the ascites.
▶️There are several causes for this imbalance, such as:
⚫Advanced liver disease is the common reason of why you may need ascites drain
⚫Other problems such as that can disrupt the normal balance of fluid production and absorption e.g. heart failure.
⚫When you are diagnosed with cancer, the cancer cells can irritate the lining of the tummy, causing it to make too much fluid.
⚫Lymph nodes in the tummy become blocked and the fluid cannot drain properly.
⚫Certain cancer that has spread to the liver raises the pressure in nearby blood vessels, which forces fluid out.
⚫The liver is damaged and cannot make enough blood proteins, so fluid leaks out of the veins into the tummy ….etc
▶️Types of ascitic (paracentesis)drain.
There are two different types of ascitic drain we do in interventional radiology.
1️⃣A small quick drain (tap) which is done to remove a small amount of fluid, normally when a catheter is inserted to remove fluid it will only stay for 6 hours or two to three days.
And sometimes, they just remove the fluid and no-catheter is inserted in cases when it is very little.
2️⃣A long-term drainage which is usually needed to remove a larger fluid and normally a catheter is left in for some time until your doctor decides when it can be removed.
Some people have these drains permanently, and this will be determined by your condition and treatment plan.
▶️ Where is the site of ascitic drain insertion?
These procedures are done when you are awake, local anaesthetic to numb the site is used, it is very rare to put you to sleep completely.
You will be given instructions on what to expect before you come for the procedure, you have the right to refuse but usually when it is recommended, it is for your own health benefit.
How is it done? Steps taken:
➡️Your doctor will explain the procedure and gain consent.
➡️If ascites are not distending the abdomen, it is prudent to undertake ultrasound examination to locate the fluid.
➡️You will be lying supine or oblique depending on the position the doctor is comfortable with.
➡️The insertion site for an ascitic drain is typically in the right or left lower quadrant of the abdomen, lateral to the midline and lower than the navel, this helps to avoid major blood vessels and organs.
➡️Ultrasound will be used to help identify the safest spot ensuring the bladder and distended bowel are avoided.
➡️The spot will be marked, after the whole set up local anaesthetic will be applied, this will help you during the procedure not to feel any pain.
➡️The drain catheter will be inserted, these come in different sizes, we normally use 6 or 8 ft drain.
➡️A drain bag will be attached, where all the fluid will go passing through the catheter to the bag.
➡️More instructions will be given by your care team on how to look after the tube and when it can be taken out.
▶️What does an ascites drain look like in images
Images showing the different steps how an drain is being inserted.
Ascites drainage side effects
Patients we see after ascites drainage feel better with a few hours of the drain being inserted.
However, some of them claim:
🔴Tiredness.
🔴Abdominal discomfort.
🔴Leakage from the drain site for up to 72 hours thou rare.
In the first hours after the procedure is done, all these are managed by rest and care by healthcare professionals.
Less common side effects include
🔴Infection: There is a risk of infection at the insertion site, or the fluid in the abdomen can become infected. That’s why the drain should not be kept for a long time because of infection that may occur.
🔴Bleeding at the insertion site is possible but usually stops on its own.
🔴Low blood pressure
🔴Organ damage and perforation are rare but there is a risk due to the drain insertion.
🔴Sometimes procedures can be abandoned because it is not possible to find a suitable area to drain fluid.
▶️What happens when ascites are drained?
Usually after the procedure is done, patients confirm after a few hours:
🟠They start feeling more comfortable because less fluid gives the diaphragm more room to move making breathing easier.
🟠The swelling, pressure, and discomfort in the abdomen reduces.
🟠Diagnostic Insights: A sample of the fluid can be sent to a lab to determine the cause of the ascites and to check for infection within the fluid.
🟠The drained fluid may also re-accumulate, and albumin may be given intravenously to help stabilize the body.
▶️Can ascites come back after being drained?
Yes, ascites fluid can and often does return after being drained through a procedure called therapeutic paracentesis.
We have patients who come back to us after weeks or months following the drainage for an ascites drain. And some patients receive a long-term indwelling drain to help manage the fluid at home.
▶️Why does the fluid come back
Ascites is usually a symptom of an underlying condition, such as advanced cancer or liver disease.
So, draining the fluid does not treat the underlying cause, the fluid will continue to build up.
In such cases, further treatments such as medication, long-term drain (pleurX) or peritoneovenous shunt may be needed to manage the condition.
▶️Can ascites be cured completely?
No, ascites cannot be completely cured directly in most cases, as it is a symptom of an underlying condition like cirrhosis or cancer.
Only when the root cause is treated then it may resolve completely. But even with this, you may require ongoing care and management because the fluid may re-accumulate.
▶️Can you have a permanent drain for ascites? What does it look like?
Yes, occasionally we do have patients where the doctor decides to put a permanent drain for ascites.
A long-term drain is usually considered when ascites fluid keeps returning after repeated drainages, even with medication
We insert a drain called PleurX catheters under the skin and connect it to a bottle or bag for drainage when the fluid builds up again.
Image showing how a PleurX catheter permanent drain look like
♦️This allows you to drain the fluid from home rather than needing repeated hospital visits.
♦️You will be taught how to manage the drain at home.
♦️This will help with your symptoms, pain and any discomfort hence improving your quality of life.
▶️How many times can you have your stomach drained from ascites?
There isn’t a set number of times you have your stomach drained from ascites; your medical team will determine how often it can be drained.
They will base on your condition, the symptoms, the treatment you are receiving, how recurring the fluid builds-up and your choice.
The principle for management of ascites aims at symptomatic relief and improvement of quality of life. Removal of 4–6 litres is usually enough to give symptomatic relief.
| Caution! Removal of more than 4-6 litres of fluid increases the risk of hypovolemia and adverse effects but may give symptomatic relief for longer until the ascites re-accumulates. |
I have seen patients who need drainage every few weeks, and others daily or weekly. And others have got long-term or permanent drains to help manage fluid build-up.
Speaking to one of the radiologists who does these procedures, here is what he had to say:
➡️While some guidelines suggest draining up to 6 Litres per session without fluid replacement for certain patients, and others recommend more.
➡️For malignant ascites, a total of 5L can be drained in 4 hours, or even drained completely over 8 hours, without the need for fluid replacement
Your doctor will monitor blood pressure and other signs to decide if fluid replacement with albumin is necessary.
▶️What is the life expectancy of someone with ascites drainage?
Life expectancy after ascites drainage varies significantly based on the underlying cause.
Ascites is the most common complication in patients with cirrhosis. It can lead to several life-threatening complications resulting in a poor long-term survival outcome.
For example, patients with cirrhosis. Often have a median survival of around 6 months if their ascites is refractory or not responsive to treatment.
For malignant ascites, the median survival is even shorter, sometimes only 20 weeks.
Huelin,2017
Some research studies that followed people who had ascites had this conclusion (Arroyo, 1989)
The probability of survival at 1 and 5 years after decompensation by ascites is about 50 and 20%, respectively.
Drainage procedures are often reassuring, aiming to improve quality of life rather than extend it significantly, and are considered for patients with a poor prognosis.
We have come to the end of this article; hope I have answered some of your questions. Wishing you a quick recovery!
Let’s share questions or comments in the section below.wishing you a quick recovery🙋
📚Source:
Moore KP, Aithal GP. Guidelines on the management of ascites in cirrhosis. Gut. 2006 Oct;55 Suppl 6(Suppl 6):vi1-12. doi: 10.1136/gut.2006.099580. PMID: 16966752; PMCID: PMC1860002.
van den Toorn LM, Schaap E, Surmont VF, Pouw EM, van der Rijt KC, van Klaveren RJ. Management of recurrent malignant pleural effusions with a chronic indwelling pleural catheter. Lung Cancer. 2005 Oct;50(1):123-7. doi: 10.1016/j.lungcan.2005.05.016. PMID: 15998551.
Huelin, P., Fortea, J. I., Crespo, J., & Fábrega, E. (2017). Ascites: Treatment, Complications, and Prognosis. InTech. doi: 10.5772/intechopen.70384
Arroyo V, Gines P, Planas R, Panes J, Rodes J. Management of patients with cirrhosis and ascites. Seminars in Liver Disease. 1986;6(4):353-369. DOI: 10.1055/s-2008-1040617
Image: sources