The Palliative Management of Refractory Cirrhotic Ascites Using the PleurX^©Catheter

Abstract

Background. Treatment options are limited for patients with refractory cirrhotic ascites (RCA). As such, we assessed the safety and effectiveness of the PleurX catheter for RCA. Methods. A retrospective analysis was performed on all patients with RCA who have undergone insertion of the PleurX catheter between 2007 and 2014 at our clinic. Results. Thirty-three patients with RCA were included in the study; 4 patients were lost to follow-up. All patients were still symptomatic despite bimonthly large volume paracentesis and were not candidates for TIPS or PV shunt. Technical success was achieved in 100% of patients. The median duration the catheter remained in situ was 117.5 days, with 95% CI of 48–182 days. Drain patency was maintained in 90% of patients. Microorganisms consistent with spontaneous bacterial peritonitis (SBP) from a catheter source were isolated in 38% of patients. The median time to infection was 105 days, with 95% CI of 34–233 days. All patients were treated for SBP successfully with antibiotics. Conclusion. Use of the PleurX catheter for the management of RCA carries a high risk for infection when the catheter remains in situ for more than 3 months but has an excellent patency rate and did not result in significant renal injury.

Permanent indwelling peritoneal catheters for palliation of refractory ascites in end‐stage liver disease: A systematic review

“…In one study with the highest prevalence of positive ascitic cultures (42%, n = 14), further clarification sought from Reinglas et al confirmed that, in addition to sampling ascitic fluid in symptomatic patients, samples were also taken routinely throughout. It was unclear if these were taken from the PIPC or the abdomen.…”

“…Rates of BP varied from 0% to 42% across individual studies with an overall combined rate of 17% (29/166). Excluding the 11 patients in Reinglas et al with catheter related organisms, the overall rate of BP was 12.7% (21 patients). If the Reinglas study was excluded as an outlier, the overall rate of BP across the remaining 15 studies was 11% (15/133).…”

“…Excluding the 11 patients in Reinglas et al with catheter related organisms, the overall rate of BP was 12.7% (21 patients). If the Reinglas study was excluded as an outlier, the overall rate of BP across the remaining 15 studies was 11% (15/133). Of these, four had the PIPC removed and received antibiotics; eight were treated with antibiotics with PIPC left in situ; one was palliated as was end of life, in the remaining two, no subsequent management was described (Table ).…”

“…It was unclear if these were taken from the PIPC or the abdomen. Organisms cultured were classified as typically associated with SBP in six (18%) and typically catheter‐associated in 11 patients (33%) . Interpretation of routine ascitic fluid sampling in PIPC remains contentious, therefore it is unclear if all were true cases of BP.…”

To salt or not to salt?—That is the question in cirrhosis

“…Ascites management comprises a stepwise approach of (i) salt restriction, (ii) diuretic therapy, (iii) large volume paracentesis with albumin substitution, (iv) transjugular intrahepatic portosystemic shunt (TIPS) and ultimately, (v) liver transplantation . Efficacy and safety of novel therapeutic approaches, such as low‐flow pump systems to remove ascites from the peritoneal cavity into the bladder or the insertion of tunnelled catheters, remain to be established . According to treatment response, ascites is grouped into uncomplicated/manageable or refractory ascites.…”