Paracentesis: A safe and effective form of therapy

Schiff, Eugene R.

doi:10.1002/hep.1840070330

Cited by 10 publications

(4 citation statements)

References 7 publications

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“…The mean time needed to 8 (10) perform the procedures was 5 (range 2 to 10) hours for spontaneous ascites filtration and reinfusion and 2 (1 to 3 5) hours for total paracentesis plus intravenous 0 albumin infusion. Operator intervention was required 7 only intermittently-that is, at the beginning and end 9 ofeach procedure and, for spontaneous ascites filtration 4 !o to 754) and reinfusion, about five to eight times (1-2 minutes 5 to 1134) each) during the procedure-for an overall period of 9 to 134) 20-30 minutes. The volume of ascites removed was to6) 9 to 4 4) similar for the spontaneous ascites filtration and to 33) reinfusion group (7 0 (3-5-11 0) 1) and for the total paracentesis group (6-4 (4-0-10-0) 1).…”

Section: Evaluation Of Treatmentsmentioning

confidence: 99%

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Comparison of spontaneous ascites filtration and reinfusion with total paracentesis with intravenous albumin infusion in cirrhotic patients with tense ascites.

Bruno

Borzio

Romagnoni

et al. 1992

BMJ

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Objective-To compare the effectiveness and safety ofspontaneous ascites filtration and reinfusion and total paracentesis plus intravenous albumin infusion in cirrhotic patients with tense ascites.Design-Randomised trial of the two treatments. Setting-Teaching hospital and district general hospital in Milan.Patients-45 consecutive cirrhotic patients with recurrent tense ascites and urinary sodium excretion rate <20 mmol/day. 35 fulfilled admission criteria and completed the study. 17 received spontaneous ascites filtration and 18 paracentesis plus albumin infusion.Main outcome measures-Body weight; urinary volume; serum and urinary electrolyte, serum fibrinogen, and plasma aldosterone concentrations; and plasma renin activity before the procedure and 24 hours and eight days afterwards.Results-Both procedures were effective in all patients. Weight decreased in both groups and showed no substantial increase after eight days. In patients receiving ascites filtration, values decreased significantly (p<001) after 24 hours for platelet count (mean relative change 0-92; 99% confidence interval 0-86 to 0.98) and serum fibrinogen concentration (0-92; 0-88 to 0.98) but returned to pretreatment values after eight days; no laboratory and clinical signs of disseminated intravascular coagulation were noted. Three patients in this group had fever, which receded spontaneously. One patient in each group had dilutional hyponatraemia.Conclusions-Spontaneous ascites filtration and reinfusion is an effective treatment for tense ascites. Reinfusion of the patient's concentrated proteins provides savings without compromising safety. IntroductionIt has recently been shown that large volume paracentesis is a rapid, safe, and effective treatment for patients with cirrhosis and tense ascites.' 4 However, intravenous infusion of albumin after paracentesis is necessary to prevent serious complications such as hypovolaemia, renal failure, or dilutional hyponatraemia.56 Moreover, commercially available albumin is currently derived from human plasma, thus implying high cost, limited availability, and potential untoward effects.

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Section: Evaluation Of Treatmentsmentioning

confidence: 99%

“…4 However, intravenous infusion of albumin after paracentesis is necessary to prevent serious complications such as hypovolaemia, renal failure, or dilutional hyponatraemia.56 Moreover, commercially available albumin is currently derived from human plasma, thus implying high cost, limited availability, and potential untoward effects.…”

Section: Introductionmentioning

confidence: 99%

Comparison of spontaneous ascites filtration and reinfusion with total paracentesis with intravenous albumin infusion in cirrhotic patients with tense ascites.

Bruno

Borzio

Romagnoni

et al. 1992

BMJ

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“…It has been shown that repeated large-volume paracentesis (4-6 l/d) plus albumin substitution (40-60 g/d) is an effective and safe therapy [20,66,78].…”

Section: Management Of Aseitesmentioning

confidence: 99%

Pathophysiology and clinical basis of prevention and treatment of complications of chronic liver disease

et al. 1991

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Chronic liver failure is characterized by the appearance of jaundice, ascites, encephalopathy and/or gastrointestinal bleeding. Acute episodes of hepatic decompensation are frequently precipitated by additional events, e.g. septicaemia, diuretic therapy or excessive protein intake. Identification, correction and treatment of these precipitating factors are first steps in the management of chronic liver failure. Nutritional support is important in the treatment of cirrhotic patients, because malnutrition is one of the major determinants of patient outcome. Management of encephalopathy reduces the appearance of gut-derived nitrogenous toxins and corrects imbalances in amino acid metabolism. Treatment of ascites is salt restriction supported by gentle and incremental administration of diuretics. Ursodesoxycholic acid has become a new and promising modality in the management of cholestatic liver diseases. If conservative therapy fails to recompensate liver function, liver transplantation may be indicated.

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“…* demonstrated the safety of 4-6 L large volume paracentesis, large volume or single total paracentesis has served as a useful clinical tool to control intractable ascites, and as a possible alternative for the first-line management of massive ascities. [3][4][5][6][7][8] Previous reports concerning the influence of large volume or total paracentesis on systemic haemodynamics or renal function have focused on the short-term changes and most studies have been conducted in patients with alcoholic cirrhosis. Whether large volume paracentesis influences the hepatic haemodynamics and alters the possibility of oesophageal variceal bleeding in the period after paracentesis has rarely been discussed.…”

Section: Introductionmentioning

confidence: 99%

Total paracentesis in non‐alcoholic cirrhotics with massive ascites: Mid‐term effects on systemic and hepatic haemodynamics and renal function

Wang

Chao

et al. 1994

J of Gastro and Hepatol

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Single total paracentesis (4.8-11 L) was performed in 23 patients with hepatitis B surface antigen (HBsAg)-positive cirrhosis and massive ascites and its effects on systemic and hepatic haemodynamics and renal function were examined over 5 days. Severe hypotension occurred in six (26.1%) patients from 6 to 54 h after paracentesis. In the remaining 17 patients, compared to the baseline, there was an increase in the cardiac output (6.1 +/- 0.3 vs 6.7 +/- 0.3 L/min, P < 0.001) and a decrease in right atrial pressure (8.8 +/- 0.8 vs 4.3 +/- 0.7 mmHg, P < 0.001), systemic vascular resistance (1160 +/- 61 vs 976 +/- 50 dyne.s.cm-5, P < 0.001), and wedged hepatic venous pressure 30 min after completion of paracentesis. After 5 days, right atrial pressure, systemic vascular resistance and wedged hepatic venous pressure returned to baseline, while the cardiac output dropped to a level lower than the baseline (5.7 +/- 0.7 L/min, P < 0.05). Hepatic venous pressure gradient had returned to baseline after 5 days. Serial tests of serum creatinine level showed an increase from day 3 (1.34 +/- 0.14 vs 1.04 +/- 0.10 mg/dL, P < 0.05). On day 5, creatinine clearance (55.7 +/- 5.4 vs 41.9 +/- 5.3 mL/min, P < 0.05) and effective renal plasma flow (351 +/- 32 vs 293 +/- 29 mL/min, P < 0.05) were decreased, compared to the baseline. Based on these data, infusion of a volume expander may be necessary for total paracentesis to avoid systemic haemodynamic complications in non-alcoholic cirrhosis.

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Paracentesis: A safe and effective form of therapy

Cited by 10 publications

References 7 publications

Comparison of spontaneous ascites filtration and reinfusion with total paracentesis with intravenous albumin infusion in cirrhotic patients with tense ascites.

Comparison of spontaneous ascites filtration and reinfusion with total paracentesis with intravenous albumin infusion in cirrhotic patients with tense ascites.

Pathophysiology and clinical basis of prevention and treatment of complications of chronic liver disease

Total paracentesis in non‐alcoholic cirrhotics with massive ascites: Mid‐term effects on systemic and hepatic haemodynamics and renal function

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