The Safety and Efficacy of Tunneled, Indwelling Peritoneal Catheter Drainage for Refractory, Non-Malignant Ascites

Kundu, Sarba; Bettmann, Michael A.

doi:10.14309/00000434-201210001-00349

Cited by 5 publications

(21 citation statements)

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“…Of the final 18 studies included, one was planned as a pilot randomised controlled trial of PIPC versus LVP but only recruited one patient into each arm. 18 Three were prospective [19][20][21] and seven retrospective cohort studies [22][23][24][25][26][27][28] ; one retrospective cohort study with matched controls 29 ; five were case series [30][31][32][33][34] and one case report. 35 Of these, 12 studies were available as full manuscripts [18][19][20][21]23,24,26,28,29,32,34,35 and six as conference abstracts.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…35 Of these, 12 studies were available as full manuscripts [18][19][20][21]23,24,26,28,29,32,34,35 and six as conference abstracts. 22,25,27,30,31,33 Ten studies reported solely on RA due to cirrhosis 18,21,22,24,27,[30][31][32]34,35 ; of these, two were cohorts including both ascites and hepatic hydrothoracies. 22,27 These studies were not excluded due to the paucity of studies identified, though those with only hepatic hydrothoracies were excluded.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…[20][21][22]24,25,[27][28][29]32,34 The remaining eight studies did not report severity scores. 18,19,23,26,30,31,33,35 Table 4 summarises the studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…All included studies reported on permanent indwelling devices; permanent indwelling (tunnelled) peritoneal catheters in twelve studies (both PleurX™ and Rocket ® ), [21][22][23][24][25][26][27][29][30][31][32]35 permanent subcutaneous port with intra-abdominal catheter (three studies) 19,20,34 and permanent tunnelled peritoneal dialysis catheters (three studies). 18,28,33…”

Section: Type Of Indwelling Cathetermentioning

confidence: 99%

“…There was a 100% technical success rate for insertion of catheters in ESLD; being inserted by interventional radiologists in eight studies, 19,20,22,23,26,27,31,34 six stating insertion was performed under ultrasound guidance. [19][20][21]23,26,34 Three studies stated drainage catheters were inserted with ultrasound guidance but not by whom.…”

Section: Procedural Insertion and Successmentioning

confidence: 99%

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

Macken

Hashim

Mason

et al. 2019

Liver International

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Background & Aims The incidence and mortality from end‐stage liver disease is increasing, with a minority eligible for liver transplantation. Ascites is the commonest complication of end‐stage liver disease and large volume paracentesis (LVP) the accepted management strategy where refractory to medical treatment. In malignant ascites, permanent indwelling peritoneal catheters (PIPC) are an established palliative intervention. The aims are to describe available data using permanent indwelling peritoneal catheters in refractory ascites due to end‐stage liver disease. Methods Using systematic review methodology, databases were searched (MEDLINE, EMBASE, CINAHL [The Cumulative Index to Nursing and Allied Health Literature], Google Scholar and Cochrane Database of Systematic Reviews from inception‐March 2018), for studies combining ascites and palliative care. Inclusion and exclusion criteria were applied to results. Results Following initial and updated searches, 225 studies were identified for full text review, 18 were eligible for final analysis. The studies displayed heterogeneity in design, reported on different indwelling catheters and were overall of low quality. Only one pilot randomised controlled trial was identified, of PIPC versus LVP, recruiting one patient into each arm. Technical insertion success was 100%, with low rates of non‐infectious complications (<12%), none life threatening. Rates of bacterial peritonitis were not unacceptably high (12.7%), considering this was an end‐stage liver disease population and only a minority utilising long‐term prophylactic antibiotics. Only one study attempted quality‐of‐life assessments; none addressed potential health economic benefits. Conclusions Despite lack of well‐designed studies, preliminary data suggests low significant complication rates; however safety and efficacy of permanent indwelling peritoneal catheters in end‐stage liver disease remains to be confirmed. Further prospective randomised controlled trials are warranted, potentially translating permanent indwelling peritoneal catheters into improved palliative care in end‐stage liver disease.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

“…[20][21][22]24,25,[27][28][29]32,34 The remaining eight studies did not report severity scores. 18,19,23,26,30,31,33,35 Table 4 summarises the studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

Section: Type Of Indwelling Cathetermentioning

confidence: 99%

Section: Procedural Insertion and Successmentioning

confidence: 99%

See 3 more Smart Citations

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

Macken

Hashim

Mason

et al. 2019

Liver International

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Short‐term intraperitoneal catheters: An ambulatory care intervention for refractory ascites secondary to cirrhosis during COVID‐19

et al. 2021

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Background and Aim Patients with refractory ascites have frequent hospital admissions, which pose exposure risks in the context of the COVID‐19 pandemic. The aim of this study was to investigate the safety and efficacy of a novel 12‐week, multidisciplinary ambulatory care program allowing frequent low‐volume ascitic drainage through a tunneled, intraperitoneal catheter (IPC). Methods Adult patients with cirrhosis complicated by refractory ascites were recruited through a liver clinic in a tertiary health service in Melbourne, Australia from April to December 2020. All patients were enrolled in a 12‐week multidisciplinary program including medical, nursing, dietetics, and pharmacy support. A Rocket Medical IPC was inserted on day 1 with 1–2 L of ascitic fluid drained over 1–3 sessions per week either at the patients' homes or at the hospital day ward. Patients' demographics, death, complications, and self‐reported outcomes were recorded. Results Twelve patients were enrolled with a median of 65‐day (interquartile range [IQR]: 16.5–93) IPC duration between April and December 2020 across two periods of COVID‐related lockdown in Melbourne, Australia. There were no IPC‐related deaths. Early removal was necessitated in three patients due to leakage, nonadherence, and bacteremia. On day 30, the median self‐reported health score increased from 50 (IQR: 50–70) to 78 (IQR: 50–85), attributable to a reduction in symptom burden. Conclusion A multidisciplinary IPC program including the use of short‐term IPC was safe and associated with a self‐reported improvement in perceptions of health. In the context of the COVID‐19 pandemic, the program aimed to reduce patient and clinician exposure, which is maintaining engagement and management of decompensated cirrhosis.

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Current treatment options of refractory ascites in liver cirrhosis – A systematic review and meta-analysis

Will

Rodrigues

Berzigotti

2022

Digestive and Liver Disease

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Background: Refractory ascites is a severe complication of liver cirrhosis and treatment options consist in large volume paracentesis, transjugular intrahepatic portosystemic shunt, alfapump®, peritoneovenous shunt and permanent indwelling peritoneal catheter. Aim: Our aim was to assess the efficacy, mortality and complications of each treatment. Methods: We performed a systematic review using Pubmed and Embase. Frequencies were summarized with Comprehensive Meta-Analysis Software. Results: Seventy-seven studies were included. In patients with transjugular intrahepatic portosystemic shunt, 1-year mortality was 33% (95% CI 0.29-0.39, I 2 = 82.1; τ 2 = 0.37; p < 0.001) with lower mortality in newer studies (26% vs. 44%). At 6 months, mortality in patients with alfapump® was 24% (95% CI 0.16-0.33, I 2 = 0.0 0; τ 2 = 0.0 0; p = 0.83), 31% developed acute kidney injury (95% CI 0.18-0.48, I 2 = 44.0; τ 2 = 0.22; p = 0.15). Mortality at 12 months was 44% (95% CI 32%-58%, I 2 = 76.7, τ 2 = 0.44, p < 0.001) in peritoneovenous shunts and 45% (95% CI 38%-53%, I 2 = 61.4, τ 2 = 0.18, p = 0.003) in large volume paracentesis, respectively. Overall mortality in patients with permanent indwelling catheters was 66% (95% CI 33%-89%, I 2 = 82.5, τ 2 = 1.57, p = 0.001).Discussion: Mortality in patients with transjugular intrahepatic portosystemic shunt was lower in newer studies, probably due to a better patient selection. Acute kidney injury was frequent in patients with alfapump®. Permanent indwelling catheters seemed to be a good option in a palliative setting.

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The Safety and Efficacy of Tunneled, Indwelling Peritoneal Catheter Drainage for Refractory, Non-Malignant Ascites

Cited by 5 publications

References 0 publications

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

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

Short‐term intraperitoneal catheters: An ambulatory care intervention for refractory ascites secondary to cirrhosis during COVID‐19

Current treatment options of refractory ascites in liver cirrhosis – A systematic review and meta-analysis

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