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Large-volume paracentesis in the management of ascites in children
R E Kramer1, R J Sokol, B Yerushalmi
1Pediatric Liver Center and Liver Transplantation Program, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Children's Hospital and University of Colorado Health Sciences Center, Denver, Colorado 80218, USA.
Insights
Large-volume paracentesis is a safe and effective treatment for tense ascites in children. Using a paracentesis needle, rather than an intravascular catheter, significantly speeds up the procedure.
Area of Science:
- Pediatric Gastroenterology
- Interventional Procedures
Background:
- Large-volume paracentesis is established for adult ascites management.
- Limited data exists on its use in pediatric patients.
- This study addresses the safety and efficacy of large-volume paracentesis in children.
Purpose of the Study:
- To evaluate the initial experience with large-volume paracentesis (> 50 ml/kg) in pediatric patients.
- To assess the safety and efficacy of this procedure for tense abdominal ascites in children.
Main Methods:
- Retrospective chart review of 21 large-volume paracentesis sessions.
- Study included seven children (6 months-18 years) with tense ascites unresponsive to other treatments.
- Procedures utilized 16-gauge or 18-gauge intravascular catheters, or a 15-gauge paracentesis needle.
Main Results:
- A mean volume of 3,129 ml (118 ml/kg) was removed.
- Procedures using the paracentesis needle were significantly faster with higher flow rates than those using catheters.
- One session reported decreased urine output as the sole complication.
Conclusions:
- Large-volume paracentesis is a safe and effective therapeutic option for pediatric tense abdominal ascites.
- The paracentesis needle offers improved speed and efficiency compared to intravascular catheters for this procedure.
Background:
Large-volume paracentesis has been evaluated for both therapeutic and diagnostic purposes in the management of ascites in cirrhotic adults. There are no published data relating to the safety, efficacy, or methods of this procedure in children. The objective of this study was to characterize the authors' initial experience with large-volume paracentesis (> 50 ml/kg of ascites) for removal of tense abdominal ascites in the pediatric population.
Methods:
Retrospective chart review was performed of 21 large-volume paracentesis sessions in seven children (ages 6 months-18 years) with tense ascites that did not respond to other measures.
Results:
Mean volume removed was 3,129 +/- 2,966 ml (mean +/- standard deviation) or 118 +/- 56 ml/kg over 2.9 +/- 3.7 hours by a 16-gauge intravascular catheter in 6 sessions, by an 18-gauge intravascular catheter in three sessions, and by a 15-gauge fenestrated, stainless-steel paracentesis needle in 12 sessions. Large-volume paracenteses performed with the paracentesis needle had significantly shorter duration of drainage and faster flow rates than those performed with the intravascular catheter. The only complication encountered was decreased urine output in one session.
Conclusions:
Large-volume paracentesis is a safe and effective therapeutic method for managing tense abdominal ascites in children. The use of the paracentesis needle significantly improved the speed and efficiency of large-volume paracentesis compared with the intravascular catheter.
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