Paracentesis

Specialties Radiology

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Specializes in ER, ICU, L&D, Now Radiology.

First I would like to say I love this forum! You all are so supportive and you all have great advice to give. On that note, Do any of you have thoughts/ideas on thearaputic paracentesis? I have been surching articles but cannot find any that are within the last 3-5 years. The concerns I am having are

1. At what point do you start using albumin?

2. Is it typical to take more than 7 liters? I have seen as many as 14 without albumin/colloids etc, and the patient goes home!

3. Do you strictly follow pts BP as a guideline?

I do realize that there are some people out there that have a paracentesis weekly and can tolerated a volume removal like that, but my concern is that these people may be driving home and have a huge fluid shift, and pass out. thoughts/ideas, your P&P's would be helpfull. :D

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Specializes in ER, ICU, L&D, Now Radiology.

Sorry, just noticed a few spelling errors. Typing tooooo fast in order to make a meeting.

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Specializes in RETIRED Cath Lab/Cardiology/Radiology.

have you asked your radiologists for any resource materials?

perhaps they have some info in their journals. you could request reading material so you can understand the rationales, and write nursing procedural protocols.

i have found a few articles (some of which i cannot access, as a nonmember of that site), but no protocols.

one name i saw frequently was a richard moreau, based in france.

http://lib.bioinfo.pl/pmid:1370217

i also found the website for the

international ascites club, which was interesting (although it had no articles or protocols).

i've never helped w/a paracentesis that pulled off 7 or more liters, so i'm afraid i can't help you w/this.

hope you can find some answers and post them here!

thanks. -- d

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whao 7 liters my best was 4 and the radiologist wanted albumin on the fifth. Also was an in pt.

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I have one long term patient with recurring therapeutic paracentesis. The albumin is ordered by the ordering specialist at 25 Gm for each 2-3 liter ascites removed.

We have removed as much as 9 liter several times over the last 1 1/2 years. At the beginning, we weren't giving albumin... the ordering MD just assumed that everyone did replacement. Once we got that straightened out and he wrote orders, the volume removed has leveled off at about 6 liter every 3-4 week instead of 6-9 liter every 2 week. This patient tolerates para very well. She hasn't been driving for over a year and has always come with a driver from the beginning.

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We have one patient who comes in about every two weeks. We have taken off 10-12 liters of fluid each time. His ordering physician is the one who orders the Albumin. In this case, his doc orders 50 grams of Alubmin. Our Radiologists NEVER order Albumin. I'm wondering if they should be???? Yikes.

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I notice the original message is from 2008 but I am wondering what facilities are doing about this now. The most I have ever taken off is 8L, and the patient received albumin replacement at 12.5gm/1L this is according to policies that the Cleveland Clinic Foundation Liver Clinic follows (I am not associated with CCF). We had had success with this. Our radiologists DO NOT order the albumin, that is ordered by the ordering physician, however, usually they do not know so I read them the orders CCF uses and they tell me to follow those guidelines.

Also, does your facility use gravity drainage bags or vaccutainers? We have always used vacutainers but now our radiologists are requesting gravity bags. If you use gravity bags, what company do you get them from? We have been using Cardinal Health and they cannot provide me with a bag that has a valve so that I can empty it several times.

Thanks for your help!!

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