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Large volume paracentesis: to do or where to do?
  1. Lucia Macken1,2,
  2. Naaventhan Palaniyappan3,4,
  3. Sumita Verma1,2,
  4. Guruprasad Aithal3,4
  1. 1 Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
  2. 2 Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  3. 3 NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
  4. 4 Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, UK
  1. Correspondence to Professor Guruprasad Aithal, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, Nottingham, UK; guru.aithal{at}

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Siau et al question the recommended landmarks for performing large volume paracentesis (LVP) ‘at least 8 cm (laterally) from the midline and 5 cm above the symphysis (pubis)’.1 In their view, while this approach avoids puncturing vessels, there remains risk of injury to underlying solid organs.2

Our aim was to provide evidence-based guidance ( where possible on the safest areas for performing therapeutic paracentesis.3 In fact, after systematically reviewing available evidence, our conclusion is that our recommended landmarks are appropriate.1 The most common (though still rare) complication overall after LVP remains bleeding (0%–2.7%) rather than …

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  • Contributors All the authors have approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; internally peer reviewed.