# Malignant ascites: paracentesis and indwelling peritoneal catheter drainage

Source: https://onco.cc/protocols/malignant-ascites-drainage/  
OnCo record `malignant-ascites-drainage` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

When cancer causes fluid to build up in the abdomen, draining it through a thin tube (paracentesis) quickly relieves bloating and breathlessness, often as a day case. Treating the cancer can slow it down. If the fluid keeps coming back, a soft tube can be left in place so it can be drained at home in small amounts. The evidence for the details of drainage is weak, so practice varies.

## Summary

The evidence for draining malignant ascites is weak: a 2006 systematic review found no randomised trials of paracentesis, diuretics or shunts, and the 2019 Cochrane update found one high-risk-of-bias trial (catumaxomab) and concluded there is insufficient evidence to recommend how drainage should be managed in gynaecological cancer. Paracentesis gives good, temporary relief and is the first-line treatment (Japanese guideline 2021). Practice carried over from cirrhosis (intermittent clamping, routine intravenous fluids or albumin, admission for several days) is not supported in malignant ascites: a UK hospice guideline (2002) drained up to 5 litres without clamping, removed drains within 6 hours and gave fluids only when indicated, and a UK series (2012) drained 21 people without clamping (4 had an asymptomatic fall in systolic pressure below 95 mm Hg, none felt unwell) and then drained to dryness as a day case, without intravenous fluids, in 18 of 19 procedures. Diuretics should be considered and judged individually (Becker 2006). Systemic treatment is strongly recommended for ovarian cancer with massive ascites (strong, evidence A) and weakly for gastric cancer. For treatment-resistant, recurrent ascites NICE recommends an indwelling peritoneal catheter (PeritX) drained into 1-litre vacuum bottles at home, which saves an estimated £1,095 a person against inpatient large-volume paracentesis. The Japanese guideline recommends against peritoneovenous (Denver) shunts because of frequent, sometimes fatal complications, and supports cell-free and concentrated ascites reinfusion (CART) with a weak grade.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: ascitic drain; abdominal paracentesis for cancer; ascitic tap; PeritX drain; Rocket peritoneal catheter; tunnelled peritoneal catheter; draining fluid from the abdomen in cancer; day-case paracentesis

## Connected records

- protocols: [Care in the last days of life: recognising dying, hydration, symptom control and anticipatory medicines](https://onco.cc/protocols/care-in-the-last-days-of-life/), [Indwelling pleural catheter: draining fluid from the chest at home](https://onco.cc/protocols/indwelling-pleural-catheter-drainage-at-home/)
- cancers: [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [Ovarian cancer](https://onco.cc/cancers/ovarian/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Peritoneal mesothelioma](https://onco.cc/cancers/peritoneal-mesothelioma/)
- technologies: [Indwelling peritoneal catheters for malignant ascites (PeritX, Rocket, Aspira, Passio)](https://onco.cc/technologies/indwelling-peritoneal-catheters/), [Pleural and peritoneal shunts (Denver shunts, ACES)](https://onco.cc/technologies/pleural-and-peritoneal-shunts/)
- drugs: [Catumaxomab](https://onco.cc/drugs/catumaxomab/)
- terms: [Malignant pleural effusion and ascites](https://onco.cc/terms/pleural-effusion/), [Peritoneal metastases from bowel cancer](https://onco.cc/terms/colorectal-peritoneal-metastases/), [Peritoneal metastasis](https://onco.cc/terms/peritoneal-metastasis/)

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