Large-volume paracentesis for patients with symptomatic tense ascites due to cirrhosis is traditionally performed as an inpatient procedure.
In this study, physicians from Rochester, Minnesota, assessed whether large-volume paracentesis could be performed safely and effectively by GI endoscopy assistants and as an outpatient procedure.
They also evaluated whether the risk of bleeding was associated with either thrombocytopenia or prolongation of the prothrombin time.
In addition, the physicians calculated the resources used for large-volume paracentesis.
|There were no significant procedure-related complications.|
In the study, GI endoscopy assistants performed 1100 large-volume paracenteses in 628 patients. Of these patients 513 had cirrhosis.
The team found that the pre-procedure mean international normalized ratio for prothrombin time was 1.7, and the mean platelet count was 50.4 x 103/L.
They found that the performance of 3 to 7 supervised paracenteses was required before competence was achieved.
The team did not observe any significant procedure-related complications, even in patients with marked thrombocytopenia or prolongation in the prothrombin time.
The mean duration of large-volume paracentesis was 97 minutes, and the mean volume of ascitic fluid removed was 8.7 L.
Dr Catherine Grabau's team concluded, "Large-volume paracentesis can be performed safely as an outpatient procedure by trained gastrointestinal endoscopy assistants".
"Ten supervised paracenteses would be optimal for training the operators carrying out the procedure."
"The practice guideline of the American Association for the Study of Liver Diseases which states that routine correction of prolonged prothrombin time or thrombocytopenia is not required is appropriate when experienced personnel carry out paracentesis."