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Paracentesis



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Oct 08, 2008 09:03 AM

Paracentesis


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.

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5 Comments
No. 1
from rnmontana12
Old Oct 08, 2008, 02:25 PM

Default Re: Paracentesis
Sorry, just noticed a few spelling errors. Typing tooooo fast in order to make a meeting.
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No. 2
from dianah
Old Oct 09, 2008, 04:20 PM

Default Re: Paracentesis
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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No. 3
from ABI 2004
Old Oct 17, 2008, 10:21 PM

Default Re: Paracentesis
whao 7 liters my best was 4 and the radiologist wanted albumin on the fifth. Also was an in pt.
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No. 4
from randismom
Old Oct 20, 2008, 02:07 PM

Default Re: Paracentesis
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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No. 5
from pezfor2
Old Nov 07, 2008, 01:10 PM

Default Re: Paracentesis
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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