Safety of paracentesis in inpatients

Duggal, Priyanka; Farah, Kaissar; Anghel, Gabriel; Marcus, Richard J.; Lupetin, A R; Babich, Michael; Sandroni, Stephen; McGill, Rita L.

doi:10.5414/cnp66171

Cited by 4 publications

(5 citation statements)

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“…Although safety of LVP, in terms of hemodynamic deterioration after therapeutic paracentesis, in patients with cirrhosis and tense ascites has been proven in a randomized controlled trial [22][23][24], this approach has been reported to be associated with an increased risk of acute renal failure and deaths in a hospital-based study [14]. Moreover, a major problem with LVP is that repeated LVPs cause protein and complement depletion from the ascitic fluid compared with diet/diuretic therapy, and this may predispose to ascitic fluid infection.…”

Section: Discussionmentioning

confidence: 98%

“…This, coupled with limited facilities for liver transplantation, transjugular intrahepatic portosystemic shunting, and other high-tech modalities, leads to the necessity to look for alternative means for mobilization of resistant ascites, even if for temporary relief. LVP, though less expensive and relatively less invasive, is nevertheless associated with various complications [13][14][15]. It is, therefore, prudent to sort out more convenient and acceptable treatment option for these patients.…”

Section: Introductionmentioning

confidence: 98%

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Effect of intravenous mannitol in mobilization of resistant cirrhotic ascites

Raza

Qureshi

Humayoun

et al. 2011

European Journal of Gastroenterology &Amp; Hepatology

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 98%

Effect of intravenous mannitol in mobilization of resistant cirrhotic ascites

Raza

Qureshi

Humayoun

et al. 2011

European Journal of Gastroenterology &Amp; Hepatology

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“…Just as would be the case in an abdominal paracentesis, potential complications include failed procedure, abdominal wall hematoma, spontaneous hemoperitoneum due to mesenteric bleeding, hollow viscus perforation, catheter loss in the abdominal cavity, and major blood vessel laceration. 8 Many of these risks are mitigated in this situation because the increase in abdominal pressure displaces much of the intra-abdominal contents. Furthermore, surgical entry of the abdominal cavity for definitive management allows for evaluation and resolution of many of the possible complications.…”

Section: Discussionmentioning

confidence: 99%

Needle Decompression of Tension Pneumoperitoneum: A Case Report

Ray

Exantus

2021

Clinical Practice and Cases in Emergency Medicine

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Introduction: Tension pneumoperitoneum is rarely encountered in the emergency department but can have disastrous effects on the body when it is. However, an emergency physician has skills that can be readily applied to needle decompress the abdomen for rapid stabilization. Case Report: A 42-year-old male arrived via ambulance after a likely overdose with mental status improvement following naloxone administration. He was found to be in respiratory distress due to a rigid, distended abdomen that required intubation for stabilization. Computed tomography imaging showed significant pneumoperitoneum with tension physiology. Surgery consultation was unable to intervene immediately, and needle decompression with an angiocatheter was performed at the bedside with immediate ventilatory improvement. Conclusion: Tension pneumoperitoneum is a rare but potentially disastrous consequence of overdose secondary to emesis and rupture of the gastric wall. Needle decompression is a skillset already in the emergency physician’s toolbox and can be applied for emergency stabilization of a tension pneumoperitoneum with proper forethought and technique.

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“…12 The heterogeneity in the risk of death is primarily due to a retrospective study of therapeutic paracentesis in hospitalized patients at a tertiary care hospital. 16 The risk of death, renal failure, hyponatremia, and hepatic encephalopathy with therapeutic paracentesis are further discussed in "Results" (see "Plasma Expanders in Therapeutic Paracentesis"). A retrospective analysis of 242 consecutive diagnostic paracenteses reported complicated bowel perforation in 0.83% (95% confidence interval [CI], 0.10%-3.0%) and residual catheter tip fragment in 0.41% (95% CI, 0.01%-2.3%).…”

Section: What Adverse Events Can Results From a Paracentesis?mentioning

confidence: 99%

“…Several prospective and retrospective studies of diagnostic and therapeutic paracentesis report on significant bleeding and death (TABLE 1). The studies are too heterogeneous to allow meaningful metaanalysis but the overall rate of significant bleeding [8][9][10][11][12][13][14][15] ranges from 0% to 2.7% and of death 9,10,12,13,16 from 0% to 17%. Variability in bleeding rates may be influenced by preexisting renal dysfunction.…”

Section: What Adverse Events Can Results From a Paracentesis?mentioning

confidence: 99%

Does This Patient Have Bacterial Peritonitis or Portal Hypertension? How Do I Perform a Paracentesis and Analyze the Results?

Wong

Holroyd‐Leduc²,

Thorpe³

et al. 2008

JAMA

104

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A 44-year-old man with cirrhosis is admitted with fever but has no obvious source of infection. His physical examination reveals ascites and minimal abdominal tenderness. Why Is This Procedure Important?In a previous Rational Clinical Examination article, Williams and Simel 1 discussed the previous scenario and suggested performing a diagnostic paracentesis to seek for the source of the patient's fever. Ascites is the most common major complication of cirrhosis. 2 The syndrome of infected ascites was first recognized and described in the European literature in the early 20th century. [2][3][4] Infection occurs in as many as 27% of cirrhosis patients admitted to the hospital for evaluation and management of symptoms associated with ascites. The presentation of spontaneous bacterial peritonitis can range from silent to overt 5 ; however, patients typically have nonspecific symptoms such as nausea, abdominal pain, malaise, fever, or mild confusion. In reports 6 from the 1970s, the mortality rate from spontaneous bacterial peritonitis exceeded 90% but recent data 7 show a lower mortality rate of 30%. Diagnosis and subsequent treat-See also Patient Page. CME available online at www.jamaarchivescme.com and questions on p 1203.Context Abdominal paracenteses are performed in patients with ascites, most commonly to assess for infection or portal hypertension and to manage refractory ascites.Objectives To systematically review evidence for paracentesis methods that may decrease risk of adverse events or improve diagnostic yield and to determine the accuracy of ascitic fluid analysis for spontaneous bacterial peritonitis or portal hypertension.

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Safety of paracentesis in inpatients

Cited by 4 publications

References 0 publications

Effect of intravenous mannitol in mobilization of resistant cirrhotic ascites

Effect of intravenous mannitol in mobilization of resistant cirrhotic ascites

Needle Decompression of Tension Pneumoperitoneum: A Case Report

Does This Patient Have Bacterial Peritonitis or Portal Hypertension? How Do I Perform a Paracentesis and Analyze the Results?

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