Can a nurse perform a paracentesis? Understanding Scope of Practice

September 26, 2025 •

4 min read

Statistics show a growing trend towards specialized procedures performed by advanced practice providers in healthcare settings. This raises important questions about delegation and scope of practice, including whether a nurse can perform a paracentesis and the responsibilities involved in the process.

Quick Summary

A Registered Nurse's (RN) role is to assist with patient preparation and monitoring during a paracentesis, while the invasive procedure itself is performed by a physician or a specifically trained and certified Advanced Practice Registered Nurse (APRN) or Nurse Practitioner (NP).

Key Points

RNs assist, APRNs perform: A Registered Nurse (RN) is responsible for assisting and monitoring during a paracentesis, but the invasive procedure is performed by a physician or an Advanced Practice Registered Nurse (APRN).
Training is required: For an APRN to perform a paracentesis, they must receive specific training and certification; it is not within the scope of practice for every advanced nurse.
Preparation and monitoring are key: The RN's role is critical for patient preparation, including checking vitals and ensuring bladder is empty, as well as monitoring for complications during and after the procedure.
State and institutional rules apply: The specific scope of practice for an APRN varies depending on state regulations and hospital policies.
Patient safety is a team effort: The interprofessional team, including physicians, APRNs, and RNs, must communicate closely to ensure patient safety and positive outcomes during a paracentesis.
Complications require vigilance: Nurses must monitor for signs of potential complications, such as hypotension, bleeding, or infection, following a paracentesis.

The Critical Distinction: RN vs. APRN

In the healthcare field, a clear distinction exists between the scope of practice for a Registered Nurse (RN) and an Advanced Practice Registered Nurse (APRN). An RN provides direct patient care, administers medication, and assists with procedures under the supervision of a physician or APRN. However, an APRN, such as a Nurse Practitioner (NP), has a higher level of education and training, often holding a master's or doctoral degree. This advanced training and certification authorize APRNs to assess, diagnose, manage patient problems, order diagnostic tests, and, in many cases, perform specific procedures independently or with limited supervision.

The Registered Nurse's Role in Paracentesis

The Registered Nurse is a vital part of the medical team during a paracentesis procedure, but their responsibilities center on preparation, assistance, and post-procedure care rather than performing the invasive tap itself. Before the procedure, the nurse is responsible for the following:

Confirming informed consent has been obtained by the provider performing the procedure.
Gathering the necessary equipment and ensuring it is sterile and ready for use.
Checking the patient's baseline vital signs (blood pressure, heart rate, oxygen saturation, temperature) and weight.
Measuring the patient's abdominal girth for post-procedure comparison.
Ensuring the patient has emptied their bladder to prevent accidental puncture.
Positioning the patient correctly, typically sitting up in bed with the head of the bed elevated, to allow for optimal fluid pooling.

During the procedure, the nurse's role shifts to close patient monitoring and assistance. They must watch for signs of complications such as hypotension (low blood pressure), tachycardia (rapid heart rate), or hypovolemia as a result of fluid shifts. After the procedure, the nurse applies a sterile dressing, continues to monitor vital signs and the puncture site for any leakage or bleeding, and documents the amount and characteristics of the fluid removed.

The Advanced Practice Registered Nurse (APRN) Role

In contrast, an APRN who has received specialized training can perform a paracentesis. Studies have shown that when performed by a trained NP, the procedure can be just as safe and effective as when performed by a physician. In fact, some hospitals have established nurse-led clinics or dedicated procedure teams, often including APRNs, to efficiently and safely perform paracentesis. The ability for an APRN to perform this procedure allows for reduced wait times and improved patient experience, especially for elective or routine therapeutic taps.

What is a Paracentesis?

A paracentesis is a medical procedure used to remove excess fluid (ascites) from the abdomen. The buildup of this fluid is often caused by conditions like liver cirrhosis, cancer, or infection. There are two main types of paracentesis:

Diagnostic Paracentesis: A small amount of fluid is removed and sent to a lab for analysis to determine the cause of the ascites or rule out infection.
Therapeutic Paracentesis: A larger volume of fluid is removed to relieve the pressure and symptoms associated with severe ascites, such as pain or difficulty breathing.

Comparison of Roles in the Paracentesis Procedure


Responsibility	Physician	Advanced Practice Registered Nurse (APRN) / Nurse Practitioner (NP)	Registered Nurse (RN)
Invasive Procedure	Performs procedure	May perform after training/certification	Assists, monitors patient during procedure
Informed Consent	Obtains from patient	Obtains from patient	Verifies it was obtained
Patient Assessment	Diagnoses condition, orders procedure	Assesses and diagnoses, may order procedure	Obtains baseline vitals, abdominal girth
Equipment Setup	Supervises setup	Supervises setup	Gathers and prepares equipment
Patient Monitoring	Supervises monitoring	Supervises monitoring	Monitors vital signs, fluid output, site
Post-Procedure Care	Orders medications, fluids	May order medications, fluids	Provides direct care and monitoring

State Regulations and Institutional Policies

It is crucial to note that the specific scope of practice for an APRN varies by state and is also governed by institutional policies. Not every APRN is authorized or trained to perform a paracentesis. The Accreditation Council for Graduate Medical Education (ACGME) has removed the requirement for internal medicine residents to demonstrate competency in paracentesis for certification, contributing to the increased number of procedures performed by APPs. This makes it essential for both patients and healthcare providers to confirm who is authorized to perform the procedure in their specific context.

For a deeper understanding of nursing regulations, consult a professional body's resources, such as the National Council of State Boards of Nursing.

Complications and Nursing Vigilance

While paracentesis is generally considered safe, potential complications exist, which makes the nurse's role in monitoring critical. These complications include:

Hypotension: A rapid decrease in blood pressure can occur after the removal of large volumes of fluid.
Bleeding: Hemorrhage or hematoma can occur at the insertion site.
Infection: Although rare, infection (peritonitis) is a possible risk.
Bladder or Bowel Perforation: Accidental puncture of a neighboring organ is a serious, though uncommon, complication.
Fluid Leakage: Leakage of ascitic fluid from the puncture site can occur post-procedure.

The nursing team's diligent monitoring helps ensure any adverse reactions are identified and addressed quickly, contributing significantly to patient safety and positive outcomes.

Conclusion

In summary, while a Registered Nurse cannot independently perform a paracentesis due to the invasive nature of the procedure, they are a fundamental part of the care team, handling crucial responsibilities from preparation to post-procedure monitoring. The actual procedure is carried out by a physician or, in many healthcare settings, a specially trained and certified Advanced Practice Registered Nurse (APRN) or Nurse Practitioner (NP). This division of labor reflects the different levels of expertise and training required for each role, ensuring the procedure is performed safely and efficiently for the patient.

Frequently Asked Questions

No, a Registered Nurse (RN) does not have the authority or training to perform the invasive procedure of a paracentesis. Their role is to assist the healthcare provider, prepare the patient, and monitor for complications.

An Advanced Practice Registered Nurse (APRN), such as a Nurse Practitioner (NP), can perform a paracentesis after receiving the necessary specialized training and certification. This is permitted in many states and institutions.

An RN's role is primarily supportive. They are responsible for preparing the patient, gathering equipment, obtaining baseline measurements, assisting the provider during the procedure, and closely monitoring the patient for any signs of complications afterward.

Yes, studies have shown that when performed by a properly trained and certified APRN, a paracentesis is a safe and effective procedure, with comparable complication rates to those performed by physicians.

After the procedure, the nurse applies a dressing, monitors the puncture site for bleeding or leakage, continues to check the patient's vital signs and abdominal girth, and documents all findings.

Nurse-led paracentesis clinics, often staffed by APRNs, can improve patient care by reducing wait times, increasing access to therapeutic procedures, and improving the patient experience.

The training typically involves a combination of didactic instruction and supervised clinical experience. For example, some programs involve a set number of supervised procedures to achieve competence.