There are no absolute contraindications to performing a paracentesis. The relative contraindications include pregnant patients or patients who have a history of abdominal surgery, a current bowel obstruction, a coagulopathy, or thrombocytopenia. Pregnancy is listed because the gravid uterus may fill the space where the procedure is normally performed. If a paracentesis is indicated, it should be performed superior to the uterine fundus. It is important to avoid sites of previous surgical incisions, because adhesions may fix the bowel wall to the abdominal wall, thus increasing the possibility of perforation. Many patients who are subjected to a paracentesis have underlying liver disease and resultant coagulopathies. Some advocate that patients with thrombocytopenia or an abnormal international normalized ratio (INR) should have platelet transfusions or factor replacement prior to performing a paracentesis. This practice is controversial and there are no controlled data to support these contentions.11 Many, however, would suggest using an infraumbilical midline, also known as a linea alba, approach in coagulopathic patients. This area is free of any vasculature, thus reducing the possibility of bleeding complications. A recent study in which the majority of ascites patients had a paracentesis performed in the LLQ did not demonstrate any bleeding complications.12 With this in mind, and given that the abdominal wall is thinner and ascitic fluid pools more in the LLQ, this location may be chosen over the infraumbilical approach when US is not being used to guide the procedure.13