Clinical Utility of Ultrasound Guidance and Skin Markings in Paracentesis

Ascites is the abnormal accumulation of fluid in the peritoneal cavity, most commonly caused by cirrhosis (75% of UK cases), malignancy (10%), and heart failure (3%). Its incidence is rising, paralleling increases in chronic liver disease and alcohol-related liver admissions. Ascitic taps are an essential procedure both for diagnostic and therapeutic purposes. Techniques include blind taps, ultrasound (US)-guided skin marking, and real-time US-guided taps. While guidelines support the use of US guidance to improve safety and success rates, there is little consensus regarding the role of US-guided skin marking, where ascitic fluid is identified and marked but the tap is subsequently performed without continuous guidance. This study audits the utility of this practice in a UK District General Hospital.

To evaluate whether US-guided skin marking ascitic tap provides clinical benefit in diagnosis and management of ascites.

A retrospective audit was conducted between July 2024 and July 2025. Patients undergoing "US-guided skin marking" were identified through the Computerised Radiology Information System (CRIS). Clinical outcomes, including success of bedside taps and complications, were extracted from electronic patient records. Success was defined as the ability to complete a safe bedside ascitic tap without requiring repeat US assessment or escalation to a radiologist-performed US-guided tap.

Nineteen patients underwent US-guided skin marking. Eleven (57.9%) were not marked due to absent (n = 3) or insufficient (n = 8) ascites. Of the eight patients marked, only one (14.3%) underwent a successful bedside tap, and this required a repeat bedside ultrasound, negating the intended benefit. Six (85.7%) required escalation to full US-guided drainage, and one patient deteriorated before intervention. The overall success rate of the procedure was 5.3% (1/19). One attempted bedside tap was abandoned due to high risk. No major complications were reported.

Findings suggest that this procedure provides limited clinical value, and consideration should be given to discontinuing its routine use in favour of immediate US-guided ascitic drainage.