Use of Subcutaneous Venous Access Ports to Treat Refractory Ascites

Rosenblum, David I.; Geisinger, Michael A.; Newman, James S.; Boden, Thom M.; Markowitz, David; Powell, Douglas P.; Mullen, Kevin D.

doi:10.1016/s1051-0443(07)61561-9

Cited by 22 publications

(43 citation statements)

References 5 publications

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“…Compared to other studies, our ports had a substantially shorter duration of port patency (median: 26.5 days), compared to a mean or median port patency duration of nearly 50 days or more. Two studies had median port patency duration of more than 250 days . In our study, 20 patients’ ports remained in situ until death and the duration of port patency was determined by the patients’ survival times.…”

Section: Discussionmentioning

confidence: 95%

“…Peritoneal ports appeared to have symptomatic benefit in studies which assessed this, however, quality of life measures were assessed quantitatively in only two studies . Complication rates were generally low among the six studies, however, one study of patients with cirrhotic ascites had a considerably higher rate of bacterial peritonitis . Another study of patients with cirrhotic and non‐cirrhotic ascites did not have a significantly increased rate of bacterial peritonitis …”

Section: Discussionmentioning

confidence: 99%

“…The first peritoneal port for drainage of ascites was reported by Sabatelli et al . Six other studies of patients with ports for malignant or refractory ascites have since been reported . Table summarises the findings from each study.…”

Section: Discussionmentioning

confidence: 99%

“…Cellulitis was defined as skin inflammation, pain, fever and leucocytosis without positive ascites culture. Peritonitis was defined by abdominal pain or fever with ascites and an absolute neutrophil count greater than 250 cells per microlitre and/or positive ascites fluid or blood culture . The catheter was considered blocked if it required specialist manipulation or removal.…”

Section: Patient Selection Criteria For Management Of Malignant Ascitmentioning

confidence: 99%

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Permanent peritoneal ports for the management of recurrent malignant ascites: a retrospective review of safety and efficacy

Chen

Wong

Hawkins

et al. 2018

Internal Medicine Journal

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Large volume paracentesis is effective in relieving the symptoms of malignant ascites, but frequent procedures are often required. Permanent peritoneal ports are an alternative to repeated procedures. We describe our experience with the use of peritoneal ports in patients at Middlemore Hospital (Auckland, New Zealand) who had a port inserted for the drainage of malignant ascites. Twenty‐eight ports were inserted in 26 patients and accessed a total of 257 times with acceptably low rates of complications including cellulitis, peritonitis and wound dehiscence.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Patient Selection Criteria For Management Of Malignant Ascitmentioning

confidence: 99%

See 2 more Smart Citations

Permanent peritoneal ports for the management of recurrent malignant ascites: a retrospective review of safety and efficacy

Chen

Wong

Hawkins

et al. 2018

Internal Medicine Journal

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“…Percutaneous peritoneovenous shunt placement [26] and subcutaneous access ports [27] have been attempted on small numbers of patients, but efficacy in large numbers of patients is unknown. An ascites bladder drain that would provide a means of ascites excretion through the bladder currently is being developed.…”

Section: Sbp Prophylaxismentioning

confidence: 99%

Treatment of refractory ascites

Velamati

Herlong

2006

Curr Treat Options Gastro

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In 1996, the International Ascites Club defined "refractory ascites" as ascites that cannot be mobilized by medical therapy or that recurs early after initial mobilization despite continued treatment. Of all patients with ascites, 5% to 10% will become refractory to medical therapy. Management of refractory ascites should attempt to control fluid accumulation, reduce the likelihood of developing complications such as spontaneous bacterial peritonitis (SBP) and the hepatorenal syndrome, and improve the patient's nutritional status and overall well-being. Measures to control ascites accumulation include documenting medication and dietary compliance and eliminating potentially nephrotoxic agents that promote sodium retention. Large volume paracentesis is an effective first step in managing these patients and can be performed routinely in an outpatient setting. When more than 5 L of fluid are removed during a paracentesis, intravenous albumin should be infused to reduce the likelihood of the patient developing postparacentesis circulatory dysfunction. Transjugular intrahepatic portosystemic shunt (TIPS) placement effectively eliminates ascites; however, there is no convincing evidence that the shunt improves mortality. Furthermore, it is associated with frequent complications of encephalopathy and shunt malfunction. We feel TIPS should be reserved for patients requiring extremely frequent paracentesis, those who develop significant postparacentesis circulatory dysfunction, or those with hepatic hydrothorax. Patients who have evidence of SBP should be treated with antibiotics and intravenous albumin infusion. Patients who have had a previous episode of SBP or an ascitic fluid protein level of less than 1.0 should receive prophylactic antibiotics. Overall, the prognosis for patients with refractory ascites remains grim, and liver transplantation is the only definitive therapy. Appropriate candidates should be identified promptly and referred for transplant evaluation.

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