Abdominal paracentesis: use of a standardised procedure checklist and equipment kit improves procedural quality and reduces complications

Fyson, Jeremy; Chapman, Laura; Tatton, Michael; Raos, Zoë

doi:10.1111/imj.13741

Cited by 10 publications

(5 citation statements)

References 17 publications

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“…Trained physicians must optimize pre- and post-procedural paracentesis safety checklists to develop system-wide protocols to help minimize any procedural complications. In fact, studies have shown that physicians utilizing a standardized procedure checklist and equipment kit demonstrated noted improvements in documentation rates, and most importantly, a significant decline in post-paracentesis complications [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Hemorrhagic Complications of Paracentesis: Aberrant Anatomy Versus Aberrant Technique - A Fatal Case of Abdominal Hemoperitoneum

Berry

2020

Cureus

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Large-volume paracentesis carries roughly a 1% risk of overall complications. Hemorrhagic complications are classified as abdominal wall hematomas, pseudoaneurysms, and hemoperitoneum. Severe hemorrhage is rare (<0.2%), with death following this complication seen in <0.02% of cases. We present a fatal case of an ultrasound-guided paracentesis leading to subsequent hemoperitoneum from an aberrant intercostal artery, causing hemorrhagic shock and death. A 47-year-old black male with decompensated alcoholic cirrhosis, model for endstage liver disease (MELD) score of 22, and Child-Pugh class C presented with a distended abdomen, international normalized ratio (INR) 1.9, and hemoglobin 9.6 g/dL. An ultrasoundguided therapeutic paracentesis was performed in the right lower quadrant with 50 mL intravenous albumin given after 4 L of uncomplicated ascitic fluid removal. The patient became hypotensive, tachycardic, and placed on pressor support medication within 12 hours after the procedure. After a complex hospital course, the patient passed away on hospital day 10 after multisystem organ failure. The patient was found to have an aberrant intercostal artery bleed secondary to the paracentesis procedure causing an abdominal hemoperitoneum.

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Section: Discussionmentioning

confidence: 99%

Hemorrhagic Complications of Paracentesis: Aberrant Anatomy Versus Aberrant Technique - A Fatal Case of Abdominal Hemoperitoneum

Berry

2020

Cureus

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“…Local procedure protocol has been shown to improve rates of informed consent, appropriate documentation, and protocol adherence. Moreover, significantly lower procedure-related complications have been reported after the introduction of these protocols [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

A Diagnostic Paracentesis Leading to Intra-abdominal Hematoma and Small Bowel Obstruction

Mehmood¹,

Khalid²,

Tow³

2022

Cureus

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It is rare for patients to have hemorrhagic complications after abdominal paracentesis. Abdominal wall hematomas and hemoperitoneum are the most common hemorrhagic complications of paracentesis. The incidence rate of hemorrhage-related complications is unknown. The risk of hemorrhage-related complications can be elevated in patients with underlying kidney disease and those who are thrombocytopenic or coagulopathic. However, there is no correlation between the degree of thrombocytopenia or coagulopathy and the risk of bleeding. It is important to identify the high-risk patients to prevent these hemorrhage-related complications. In rare instances, secondary complications can develop from hemoperitoneum. We present a case of a cirrhotic patient who underwent a diagnostic paracentesis leading to subsequent intra-abdominal hematoma followed by small bowel obstruction (SBO) due to large abdominal hematoma compressing small bowel loops.

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“…Paracentesis is best performed by a doctor who is trained for the procedure. 31 Recently introduced co-axial insertion technique is better than the routine z-technique of inserting cannula for Large Volume Paracentesis (LVP). 32 LVP is removal of an amount greater than 5L of ascitic fluid and is performed when tense ascites leads to discomfort and respiratory embarrassment or in cases with refractory ascites.…”

Section: Diuretics and Salt Restrictionmentioning

confidence: 99%

“…32 LVP is removal of an amount greater than 5L of ascitic fluid and is performed when tense ascites leads to discomfort and respiratory embarrassment or in cases with refractory ascites. 31 Thrombocytopenia and coagulopathy do not preclude paracentesis FFP transfusion is not needed for correction of deranged INR prior to paracentesis for countering deranged INR. 33 Colloid Replacement: LVP ought to be followed by intravenous human albumin infusion to decrease the chances of PPCD.…”

Section: Management Of Large Volume or Tense Ascites Treatment Options Available Arementioning

confidence: 99%

HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan

et al. 2020

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Approximately one half of patients develop ascites within 10 years of diagnosis of compensated cirrhosis. It is a poor prognostic indicator, with only 50% surviving beyond two years. Mortality worsens significantly to 20% to 50% at one year if the ascites becomes refractory to medical therapy. Pakistan has one of the highest prevalence of viral hepatitis in the world and patients with ascites secondary to liver cirrhosis make a major percentage of both inpatient and outpatient burden. Studies indicate that over 80% of patients admitted with ascites have liver cirrhosis as the cause. This expert opinion suggests proper assessment of patients with ascites in the presence of underlying cirrhosis. This expert opinion includes appropriate diagnosis and management of uncomplicated ascites, refractory ascites and complicated ascites (including spontaneous bacterial peritonitis (SBP) ascites, hepatorenal syndrome (HRS) and hyponatremia. The purpose behind this expert opinion is to help consultants, postgraduate trainees, medical officers and primary care physicians optimally manage their patients with cirrhosis and ascites in a resource constrained setting as is often encountered in a developing country like Pakistan. doi: https://doi.org/10.12669/pjms.36.5.2407 How to cite this:Ali B, Salim A, Alam A, Zuberi BF, Ali Z, Azam Z, et al. HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.2407 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abdominal paracentesis: use of a standardised procedure checklist and equipment kit improves procedural quality and reduces complications

Abstract: The PC and EK improved rates of informed consent, appropriate documentation and protocol adherence. Significantly fewer procedure-related complications occurred after introduction of these tools.

Cited by 10 publications

References 17 publications

Hemorrhagic Complications of Paracentesis: Aberrant Anatomy Versus Aberrant Technique - A Fatal Case of Abdominal Hemoperitoneum

Hemorrhagic Complications of Paracentesis: Aberrant Anatomy Versus Aberrant Technique - A Fatal Case of Abdominal Hemoperitoneum

A Diagnostic Paracentesis Leading to Intra-abdominal Hematoma and Small Bowel Obstruction

HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan

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