The use of bedside ultrasound and community-based paracentesis in a palliative care service

Abstract

INTRODUCTION: There is little information, particularly in New Zealand, on the use of ultrasound to enhance clinical decision-making in a specialist palliative care service. Technological advances have resulted in increasingly portable, user-friendly ultrasound machines that can be used in the home setting to offer convenient access to this treatment option. AIM: To evaluate the clinical use of portable ultrasonography in the management of abdominal ascites in a community palliative care service. METHODS: Patients referred to the Nurse Maude Hospice and Palliative Care Service requiring assessment for abdominal ascites over 12 months were scanned using a newly purchased handheld ultrasound machine. The patients had a variety of diagnoses; the most common diagnosis was ovarian cancer. RESULTS: Forty-one ultrasound scans performed for 32 patients to assess for ascites drainage were recorded. Fluid was identified in 19 assessments and drainage undertaken in 17. Over half the scans were completed at home, allowing nine procedures to be performed safely and conveniently, which reduced time spent at the local hospital. There were no major complications. DISCUSSION: Ultrasonography is a tool that has not previously been utilised in palliative care locally, but has significant potential patient benefits. This novel use of technology also highlighted potential cost savings to the patient and health system, which may be beneficial to other palliative care services in New Zealand. KEYWORDS: Ascites; community health services; palliative care; paracentesis, ultrasonography

The Use of Handheld Ultrasound Devices – An EFSUMB Position Paper

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“…[6][7][8] Many areas now have services that offer portable X-ray and ultrasound in the home, and some large house call programs provide these ancillary services, which also create added revenue. 9 Smartphone apps can assist care in the home by providing rhythm strips, vision testing, drug databases, decision support, and much more. 10,11 Finally, cloud-based electronic medical records allow access to patients' medical records virtually anywhere.…”