Outcomes following nurse-led day-case paracentesis

Therapeutic paracentesis (TP) is a key symptom-relieving intervention in refractory ascites. In response to rising demand, Nottingham University Hospitals NHS Trust was among the first UK centres to introduce a nurse-led, day-case TP service. This study evaluates the complications and mortality associated with this service.

Retrospective analysis was undertaken on patients with decompensated cirrhosis who underwent nurse-led day-case TP between 1 January 2017 and 31 December 2021. Clinical and outcome data were systematically collected.

A total of 2,530 TP procedures were performed on 340 patients. Minor (self-limiting) complications occurred in 54 cases (2.1%). In 22 cases (0.9%), patients were admitted to hospital within 7 days of TP - the reasons for admission were bacterial peritonitis (n = 11), abdominal pain (n = 3), and leakage of ascitic fluid (n = 7) or bleeding (n = 1) from the puncture site. There were no cases of abdominal visceral perforation or in-hospital deaths among those admitted. About 290 patients were included in 1-year survival analysis. About 177 (61%) were alive 1 year after their first TP. The median time from first TP to death was 125 days (IQR 43-210). The 30- and 90-day mortality rates after TP were 21.0% and 33.1%, respectively. Older age (p < 0.001), hepatocellular carcinoma (p < 0.001) and ongoing alcohol use (p < 0.001) were independently associated with 1-year mortality.

Nurse-led, day-case TP is an effective and safe approach for managing refractory ascites in decompensated cirrhosis. Mortality remains high, particularly in patients with hepatocellular carcinoma and ongoing alcohol use.