Vascular Ultrasonography: A Novel Method to Reduce Paracentesis Related Major Bleeding

Abstract

Paracentesis is a core competency for hospitalists. Using ultrasound for fluid localization is standard practice and involves a low-frequency probe. Experts recommend a "2-probe technique, " which incorporates a high-frequency ultrasound probe in addition to the low-frequency probe to identify blood vessels within the intended needle path. Evidence is currently lacking to support this 2-probe technique, so we performed a pre- to postintervention study to evaluate its effect on paracentesis-related bleeding complications. From February 2010 to August 2011, procedures were performed using only low-frequency probes (preintervention group), while the 2-probe technique was used from September 2011 to February 2016 (postintervention group). A total of 5777 procedures were performed. Paracentesis-related minor bleeding was similar between groups. Major bleeding was lower in the postintervention group (3 [0.3%], n = 1000 vs 4 [0.08%], n = 4777; P = 0.07). This clinically meaningful trend suggests that using the 2-probe technique might prevent paracentesis-related major bleeding.

Abdominal Paracentesis: Safety and Efficacy Comparing Medicine Resident Bedside Paracentesis vs. Paracentesis Performed by Interventional Radiology

“…Furthermore we did not show a significant difference in the transfusion rates of platelets and/or Fresh Frozen Plasma between the two groups. The discrepancy in transfusion of packed red blood cells may in part be attributed to the advent of bedside ultrasound, which has improved the safety profile of bedside procedures [9,24], and also to the fact that IR follows separate guidelines for transfusion criteria of all blood products. The consensus guidelines published in the Journal of Vascular and Interventional Radiology (JVIR) recommends platelet transfusion to maintain counts > 50,000/uL and INR correction to < 2.0 while AASLD discourages the prophylactic use of fresh frozen plasma or platelets before paracentesis regardless of the platelet count or prothrombin time [14,25].…”

Recommendations on the Use of Ultrasound Guidance for Adult Abdominal Paracentesis: A Position Statement of the Society of Hospital Medicine

“…In this study, which included 5,777 paracenteses, paracentesis-related minor bleeding rates were similar in both groups, but major bleeding rates were less in the group utilizing color flow Doppler to evaluate for superficial vessels (0.3% vs 0.08%); differences found between groups, however, did not reach statistical significance (P = .07). 79…”