Post-Paracentesis Care Instructions

For a Patient on Maintenance Dialysis (1 Year)

NIGHT PRECAUTIONS (After the Procedure)

• Lie on the opposite side from the puncture site for the first 2 hours after the tap - this helps the puncture site seal properly and reduces fluid leak.
• Rest completely for the remainder of the day and night. Do not do any physical work or heavy lifting.
• Sleep in a semi-reclined or slightly propped position (head at 30-45 degrees) if there is any shortness of breath - this is common after fluid removal.

• Keep the bandage/dressing dry and in place overnight. Do not touch or remove it.
• If you notice leaking fluid through the dressing, apply gentle pressure with a clean cloth and inform your doctor or nurse the next morning.
• Watch for: bleeding, increasing wetness at the site, swelling, or redness.

• It is normal to feel some abdominal discomfort or mild soreness at the site.
• If you develop sudden difficulty breathing, chest tightness, or worsening breathlessness - this is an emergency. Go to the hospital immediately.

• Since you are on maintenance dialysis, your fluid restriction continues as prescribed by your nephrologist (typically 500 - 1000 mL/day depending on your urine output).
• Do NOT drink extra fluids thinking the belly is now "empty" - fluid will re-accumulate faster if you exceed your fluid limit.

MORNING PRECAUTIONS (Next Day)

• After 24 hours, you may carefully remove the bandage and gently wash the site with soap and warm water.
• Keep the area dry and covered with a clean dressing.
• No tub baths, swimming, or submerging in water for 3 days.
• Showering is fine after 24 hours, but do not let a strong stream of water directly hit the site.

• Weigh yourself every morning at the same time, on the same scale, after using the toilet and before eating.
• Record the weight. Report to your doctor if you gain more than 1-2 kg in 2-3 days - this can signal rapid fluid re-accumulation.

IMPORTANT CLINICAL NOTES (For Caregiver / Medical Team)

1. Albumin infusion: If more than 5 liters was removed, the patient should have received or should receive 6-8 g IV albumin per liter of ascites removed to prevent post-paracentesis circulatory dysfunction (PPCD) and acute kidney injury. This is a AASLD/BSG guideline recommendation.
2. Diuretics: Given that the patient is on dialysis, standard diuretics (spironolactone, furosemide) are likely already limited or modified. Do NOT adjust diuretics without nephrologist guidance.
3. NSAIDs are contraindicated - they impair prostaglandin synthesis, worsen renal function, and can precipitate acute kidney injury.
4. Labs to check (next dialysis session or within 48 hours):
   • Serum sodium, potassium, creatinine
   • Blood pressure (hypotension is a sign of PPCD)
   • CBC if fever develops
5. Dialysis schedule: Do NOT miss the next scheduled dialysis session - fluid may shift rapidly and dialysis helps remove excess volume safely.

DIET GUIDELINES

For the Dialysis + Ascites Patient (Combined Restrictions)

Practical Eating Tips

• Eat small, frequent meals every 2-4 hours rather than large meals (large meals increase abdominal pressure).
• Choose high-protein, low-sodium options: eggs (whites), fish, chicken (without skin, without marinade), tofu.
• Avoid canned foods, pickles, papad, namkeen, packaged snacks - all are very high in sodium.
• Avoid coconut water, fruit juices, and sports drinks - they are high in potassium and fluid.
• Late evening snack (e.g., a small portion of bread or rice) is recommended to reduce overnight fasting - this helps reduce protein breakdown overnight (especially important in cirrhotic patients).

FOLLOW-UP

• Next dialysis session: Attend as scheduled, inform the dialysis nurse about the paracentesis.
• Liver specialist / gastroenterologist: Follow up within 1-2 weeks to review ascites management.
• Repeat paracentesis: Will be guided by how fast fluid re-accumulates - your doctor will schedule this.

Note: These instructions are for general guidance. Always follow the specific advice of your treating nephrologist, hepatologist, and dialysis team, as management must be individualized.