Paracentesis is performed to remove ascitic fluid for diagnostic and/or therapeutic purposes. A paracentesis can be attempted in the left lower quadrant of the abdomen, 3 cm superior and medial to the anterior superior iliac crest. Palpation should be done beforehand to make sure there is not a massively enlarged spleen. Likewise, the right lower quadrant can be used in the same relation to the anterior superior iliac crest, 3 cm above and medial. Care must be taken to palpate for an enlarged liver. The midline can also be accessed 2 cm below the umbilicus in the linea alba. The Inferior Epigastric Arteries run vertically several cm's lateral to the midline. The above approaches should shield them from puncture. On all three approaches, palpation of the urinary bladder must also take place to rule out bladder obstruction and massive enlargement of the bladder encroaching on the procedural field. Ultrasound, if available, can be utilized to clear the field definitively.