Large volume paracentesis: to do or where to do?

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 (https://blogs.bmj.com/gut/) 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 organ …