Outcomes following nurse-led day-case paracentesis

Area of Science:

• Hepatology
• Gastroenterology
• Clinical Nursing

Background:

• Refractory ascites is a common complication of decompensated cirrhosis.
• Therapeutic paracentesis (TP) is a primary intervention for symptom relief.
• Rising demand necessitated innovative service delivery models.

Purpose of the Study:

• To evaluate the safety and efficacy of a nurse-led, day-case therapeutic paracentesis service.
• To assess complication rates and mortality associated with this model of care.
• To identify factors influencing patient survival post-TP.

Main Methods:

• Retrospective analysis of patients with decompensated cirrhosis undergoing nurse-led day-case TP.
• Data collected from January 2017 to December 2021.
• Systematic collection of clinical and outcome data, including complications and survival.

Main Results:

• 2,530 procedures performed on 340 patients.
• Minor complications occurred in 2.1% of cases; 0.9% required hospital admission.
• One-year survival was 61%; 30-day and 90-day mortality rates were 21.0% and 33.1%.
• Independent predictors of 1-year mortality included older age, hepatocellular carcinoma, and ongoing alcohol use.

Conclusions:

• Nurse-led, day-case TP is a safe and effective management strategy for refractory ascites.
• The service successfully manages symptom relief with low complication rates.
• High mortality persists in this patient group, highlighting the need for targeted interventions for those with hepatocellular carcinoma and alcohol use.