Palliative Paracentesis in the Home Setting: A Case Series

Ota, Ken S.; Schultz, Nicholas; Segaline, Nicole

doi:10.1177/1049909120963075

Cited by 10 publications

(5 citation statements)

References 12 publications

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“…Comparing the primary malignancy with fluid volume, ascitic fluid collected in gastrointestinal and gynecologic malignancies was of lower volume (Table 2) than other malignancies. Although these malignancies are often associated with malignant ascites [17], the apparent lower fluid volume may be attributed to more frequent admissions and the adoption of outpatient or home paracentesis for these patients where recurrence is frequent and expected [20, 21].…”

Section: Discussionmentioning

confidence: 99%

Number Needed to Diagnose in Malignant Ascites: Effects of Volume, Repeating Collection, and Primary Malignancy on Diagnostic Performance in Peritoneal Fluid Cytology

Chow

Ngai

et al. 2023

Acta Cytologica

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Introduction Volume recommendations of 80-200ml have been proposed for peritoneal fluid cytology. While cut-offs are impractical when volume is limited by the amount present and disease factors, collections, however, can be repeated. This study addresses adequacy and number needed to diagnose by comparing diagnostic agreement to volumes in single specimens, total volumes collected daily, and within admissions. The diagnostic yield of repeating collection within a single day, admission, and throughout admissions of a patient’s lifetime was also investigated. Methods Peritoneal fluid cytology specimens over a 27-year period were retrieved, and matched by collection date, admission number and patient number. Case notes were reviewed to establish all cases of malignant ascites. Results In total, 19,392 specimens from 14,327 admissions and 11,089 patients were retrieved, with 1,531 patients confirmed with malignant ascites. Agreements between cytologic diagnoses within the same day and admission were high (κ>0.8). Fluid volume increased with grade of cytologic diagnosis (p<0.001), and greater volume was associated with higher discordance (p<0.05). Specimens of 60-100ml showed the best diagnostic concordance. To achieve a 99.5% diagnostic rate, three sequential aliquots, collections from two different days in an admission, or three admissions within a lifetime is required. The diagnostic yield of one aliquot within batches from the same day was only 88.9%. Gastrointestinal (p=0.040), gynecologic (p=0.005) and lung (p<0.001) malignancies required the least repeats for diagnosis. Conclusions Omission of any fluid from laboratory submission is strongly discouraged. As a simple rule, three repeats are necessary for excluding malignant ascites.

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Section: Discussionmentioning

confidence: 99%

Number Needed to Diagnose in Malignant Ascites: Effects of Volume, Repeating Collection, and Primary Malignancy on Diagnostic Performance in Peritoneal Fluid Cytology

Chow

Ngai

et al. 2023

Acta Cytologica

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“…Palliative paracentesis is an ambulatory procedure usually done under ultrasound guidance and causes relief of symptoms in 90 % of patients. Active and early involvement of palliative care team is crucial [ [220] , [221] , [222] ].…”

Section: Methodsmentioning

confidence: 99%

6th and 7th International consensus guidelines for the management of advanced breast cancer (ABC guidelines 6 and 7)

Cardoso,

Paluch-Shimon,

Schumacher-Wulf

et al. 2024

The Breast

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“…This approach eliminates the need for patient transfer and admission in cases of symptomatic ascites, while also preventing unnecessary transfers when paracentesis is not warranted. Consequently, this method engenders satisfaction among patients and their families [ 24 , 111 ].…”

Section: Reviewmentioning

confidence: 99%

Home Ultrasound: A Contemporary and Valuable Tool for Palliative Medicine

Monteiro,

França de Santana,

Morais

et al. 2024

Cureus

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This narrative review explores the application of point-of-care ultrasound (POCUS) in palliative care and its feasibility in home care settings. POCUS has the potential to streamline diagnostic strategies without patient transfer to the hospital, expedite timely symptomatic relief, and reduce complications from specific palliative interventions. The advent of handheld ultrasound devices has made it an attractive diagnostic and interventional adjunct in acute palliative care. POCUS has gained widespread acceptance as part of routine care in emergency medicine and intensive care, guiding certain procedures and increasing their safety. The modernization and miniaturization of ultrasound equipment have made ultra-portable devices available, allowing for better-quality images at affordable prices. Handheld devices have the potential to revolutionize everyday clinical practice in home-based palliative care, contributing to important bedside clinical decisions. Palliative care patients often require diagnostic examinations in the last months of their lives, with CT being the most frequently performed imaging procedure. However, CT imaging is associated with high costs and burdens, leading to increased suffering and impaired quality of life. Clinical ultrasound, a dialogic imaging modality, offers a safer and more efficient approach to palliative care. POCUS applications, which are cost-effective, non-invasive, and well-tolerated, can be used to improve patient satisfaction and diagnostic understanding. POCUS is a valuable tool in palliative care, improving diagnostic accuracy and reducing the time to diagnosis for various pathologies. It is a standard of care for many procedures and improves patient safety. However, there are limitations to POCUS in palliative care, such as operator-dependent examination variability and limited availability of trained professionals. To overcome these limitations, palliative care physicians should receive mandatory training in POCUS, which can be incorporated into the core curriculum. Additionally, ultrasound teleconsulting can assist less experienced examiners in real-time examinations. The literature on POCUS in palliative care is limited, but research on patient-oriented outcomes is crucial. POCUS should be considered a supplement to good clinical reasoning and regulated radiological evaluations.

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Palliative Paracentesis in the Home Setting: A Case Series

Cited by 10 publications

References 12 publications

Number Needed to Diagnose in Malignant Ascites: Effects of Volume, Repeating Collection, and Primary Malignancy on Diagnostic Performance in Peritoneal Fluid Cytology

Number Needed to Diagnose in Malignant Ascites: Effects of Volume, Repeating Collection, and Primary Malignancy on Diagnostic Performance in Peritoneal Fluid Cytology

6th and 7th International consensus guidelines for the management of advanced breast cancer (ABC guidelines 6 and 7)

Home Ultrasound: A Contemporary and Valuable Tool for Palliative Medicine

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