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Related Experiment Videos

Performance standards for therapeutic abdominal paracentesis.

Catherine M Grabau1, Sharon F Crago, Linda K Hoff

  • 1Advanced Liver Diseases Study Group, Division of Gastroenterology and Hepatology and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.

Hepatology (Baltimore, Md.)
|September 16, 2004
PubMed
Summary

Gastrointestinal endoscopy assistants can safely perform large-volume paracentesis as an outpatient procedure for ascites. This procedure showed no increased bleeding risk, even with low platelets or prolonged clotting times.

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Area of Science:

  • Gastroenterology
  • Hepatology
  • Clinical Procedures

Background:

  • Large-volume paracentesis is the standard treatment for symptomatic tense ascites in cirrhosis patients.
  • Traditionally, this procedure is performed by physicians as an inpatient service.

Purpose of the Study:

  • To evaluate the safety and efficacy of large-volume paracentesis performed by gastrointestinal endoscopy assistants.
  • To assess the association between bleeding risk and thrombocytopenia or prolonged prothrombin time.
  • To determine the resources utilized for this procedure.

Main Methods:

  • Gastrointestinal endoscopy assistants performed 1,100 large-volume paracenteses in 628 patients, including 513 with cirrhosis.
  • Competence was achieved after 3 to 7 supervised procedures.

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  • Patient data included pre-procedure international normalized ratio (INR) and platelet counts.

    • Main Results:

    • No significant procedure-related complications occurred, irrespective of thrombocytopenia or prolonged prothrombin time.
    • The mean procedure duration was 97 minutes, with an average fluid removal of 8.7 liters.
    • Training involved 3-7 supervised paracenteses for competence.

    Conclusions:

    • Trained gastrointestinal endoscopy assistants can safely and effectively perform large-volume paracentesis as an outpatient procedure.
    • Ten supervised paracenteses are recommended for optimal operator training.
    • Existing guidelines regarding the non-correction of coagulopathy are appropriate for experienced personnel.