Routine Diagnostic Paracentesis for Ascites Routine Diagnostic Paracentesis for Ascites - Emergency MedicineSkip to contentSkip to searchSkip to footerWashington University School of Medicine in St. LouisEmergency MedicineOpen MenuBackCloseMenuSearch for:SearchClose Search * WelcomeWelcome * Mission * Videos * Clinical Sites * Explore St. Louis * Our TeamOur Team * Faculty * APP * News * EventsEvents * BJH & WU EMS Critical Care Symposium * Lewis Health Policy Symposia * Jermyn LecturesJermyn Lectures * 2019 * Women in Medicine Symposium * Code 3 Conference * Project PREPARE * Guidelines for Patient Data Request Management * EM Accounting ServicesOpen Search Routine Diagnostic Paracentesis for Ascites Washington University Emergency Medicine
Lessons from a paracentesis Lessons from a paracentesis – Clinical Correlations Clinical Correlations * AboutAboutAwardsPeer Review * CategoriesBedside RoundsChiefs' Inquiry CornerCORE IM PodcastDiseases 2.0EthicsEvolution and MedicineGamechanger?Healthcare PolicyHotSpotsMystery QuizMyths and RealitiesPrimeCutsSpotlightSee All Categories * SystemsAllergy experiences as physicians and trainees in internal medicine.By Simone Blaser, MDMy second palliative paracentesis did not go as smoothly as my first. At my first, I inserted the catheter into the patient’s taut belly, and when the catheter suddenly gave way and I felt the pop of the punctured peritoneum, I almost gasped. The straw-colored fluid began to drain out, from one suction container to the next
When treating patients for spontaneous bacterial peritonitis (SBP), what is the role for follow-up paracentesis to reassess the ascitic fluid? Chiefs’ Inquiry Corner – 9/28/2021 – Clinical Correlations Clinical Correlations * AboutAboutAwardsPeer Review * CategoriesBedside RoundsChiefs' Inquiry CornerCORE IM PodcastDiseases 2.0EthicsEvolution and MedicineGamechanger?Healthcare of the NYU Langone Internal Medicine Residency give quick-and-easy, evidence-based answers to interesting questions posed by house staff, both in their clinics and on the wards.Click to toggle the answers!Bellevue Inpatient: When treating patients for spontaneous bacterial peritonitis (SBP), what is the role for follow-up paracentesis to reassess the ascitic fluid? According to the American Association
Early paracentesis is associated with better prognosis compared to late or no-paracentesis in hospitalized veterans with cirrhosis and ascites. Guidelines recommend that all hospitalized patients with cirrhosis and ascites receive an early (<24 h from admission) paracentesis. However, national data are not available regarding compliance with and consequences of this quality metric. We utilized the national Veterans Administration Corporate Data Warehouse and validated International Classification of Disease codes to evaluate the rate and subsequent outcomes of early, late and no paracentesis for patients with cirrhosis and ascites during their first inpatient admission between 2016-2019. Of 10,237 patients admitted with a diagnosis of cirrhosis with ascites, 14.3% received an early paracentesis
Paracentesis outcomes from a medicine procedure service at a tertiary care transplant center. Paracentesis is a commonly performed procedure with overall low complication rates. There is a paucity of modern data investigating outcomes for inpatients using standardized point of care ultrasound. We aimed to evaluate complication rates and outcomes of paracentesis in patients in the inpatient setting of a large tertiary transplantation center. We identified patients with ascites of multiple etiologies undergoing paracentesis by a medicine procedure service at a university center. Univariate and multivariate analyses were conducted to identify clinical and demographic factors associated with kidney injury (AKI) or significant HGB drop (≥2 g/dL). Of 1746 patients, 12% of patients receiving
Assessment of the 2021 AASLD Practice Guidance for Albumin Infusion in Elective Therapeutic Paracentesis: A Regression Discontinuity Design. The 2021 American Association for the Study of Liver Disease (AASLD) Practice Guidance recommends albumin infusion when removing ≥ 5 liters of ascites to prevent post-paracentesis circulatory dysfunction. However, the optimal criteria and scenarios for initiating albumin infusion subsequent to therapeutic paracentesis (TP) have been subject to limited scientific inquiry. We conducted a retrospective cohort study at a U.S. academic healthcare center. Participants received elective, outpatient TP between July 2019 and December 2022. Patients with spontaneous bacterial peritonitis, post-TP clinical adjustments, and/or hospitalization were excluded
Management of coagulopathy among patients with cirrhosis undergoing upper endoscopy and paracentesis: Persistent gaps and areas of consensus in a multispecialty Delphi. Background and Aims Patients with cirrhosis have abnormal coagulation indices such as a high international normalized ratio (INR) and low platelet count, but these do not correlate well with peri-procedure bleeding risk. We sought to develop consensus among the multiple stakeholders in cirrhosis care to inform process measures that can help improve the quality of the peri-procedure management of coagulopathy in cirrhosis. Approach and Results We identified candidate process measures for peri-procedure coagulopathy management in multiple contexts relating to the performance of paracentesis and upper endoscopy. An 11-member panel
Outpatient paracentesis for the management of ovarian hyperstimulation syndrome: study protocol for the STOP-OHSS randomised controlled trial. Ovarian hyperstimulation syndrome (OHSS) is the most significant short-term complication of pharmacological ovarian stimulation. Symptoms range from mild abdominal discomfort to rare complications such as renal failure, thromboembolism and respiratory distress syndrome.Currently, clinical practice typically involves monitoring the patient until the condition becomes severe, at which point they are admitted to hospital, where drainage of ascitic fluid (paracentesis) may take place. Preliminary studies have indicated that earlier outpatient paracentesis may reduce the progression of OHSS and prevent hospitalisation in women. This UK, multicentre
Use of Anterior Chamber Paracentesis for Diagnosis in Viral Anterior Uveitis. In ophthalmic practices in the Intelligent Research in Sight (IRIS) Registry, 1.6% of eyes with viral anterior uveitis underwent anterior chamber paracentesis. When performed, anterior chamber paracentesis was associated with a change in diagnosis in 42% of cases.
A Machine Learning Algorithm Avoids Unnecessary Paracentesis for Exclusion of SBP in Cirrhosis in Resource-Limited Settings. Despite the poor prognosis associated with missed or delayed spontaneous bacterial peritonitis (SBP) diagnosis, <15% get timely paracentesis, which persists despite guidelines/education in the US. Measures to exclude SBP non-invasively where timely paracentesis cannot be performed could streamline this burden. Using Veterans Health Administration Corporate Data Warehouse (VHA-CDW) we included cirrhosis patients between 2009-2019 who underwent timely paracentesis and collected relevant clinical information (demographics, cirrhosis severity, medications, vitals, and comorbidities). XGBoost-models were trained on 75% of the primary cohort, with 25% reserved for testing
Randomized crossover trial of 'Roll-over' technique of abdominal paracentesis versus standard technique in suspected malignant ascites. The sensitivity of single abdominal paracentesis for diagnosis of peritoneal carcinomatosis (PC) varies from 40-70%. We hypothesized that rolling-over the patient before paracentesis might improve the cytological yield. This was a single center pilot study with a randomized cross-over design. We compared the cytological yield of fluid obtained by roll-over technique (ROG) with standard paracentesis (SPG) in suspected PC. In the ROG group, patients were rolled side-to-side thrice, and the paracentesis was done within 1 minute. Each patient served as their own control, and the outcome assessor (cytopathologist) was blinded. The primary objective was to compare
Daily Low-Volume Paracentesis and Clinical Complications in Patients With Refractory Ascites. The potential association of low-volume paracentesis of less than 5 L with complications in patients with ascites remains unclear, and individuals with cirrhosis and refractory ascites (RA) treated with devices like Alfapump or tunneled-intraperitoneal catheters perform daily low-volume drainage without with liver cirrhosis, RA, and a contraindication for a transjugular intrahepatic portosystemic shunt who received either device implantation or standard of care (SOC; ie, repeated large-volume paracentesis with albumin infusion), and were hospitalized between 2012 and 2020 were included. Data were analyzed from April to October 2022. Daily ascites volume removed. The primary end points were 90-day
Accuracy and safety of a novel aqueous humor collector versus 29 G insulin syringe for anterior chamber paracentesis and aqueous humor collection: A multicenter randomized clinical trial.
Early short-term abdominal paracentesis drainage in moderately severe and severe acute pancreatitis with pelvic ascites. We sought to evaluate the effect of early short-term abdominal paracentesis drainage (APD) in moderately severe and severe acute pancreatitis (MSAP/SAP) with pelvic ascites. A total of 135 MSAP/SAP patients with early pelvic ascites were divided into the Short-term APD group
Midodrine versus Albumin to Prevent Paracentesis Induced Circulatory Dysfunction in Acute on Chronic Liver Failure Patients in the Outpatient Clinic-a Randomized Controlled Trial. Paracentesis-induced circulatory disturbance (PICD) occurs in 12-20% of patients receiving human albumin for large-volume paracentesis, and can occur at lower than five liter paracentesis in acute-on-chronic liver failure (ACLF). Albumin infusions are associated with higher costs and more prolonged daycare admissions. The aim of the study was to determine if oral midodrine-hydrochloride can prevent PICD in these patients by increasing the mean arterial pressure (MAP). This open-labeled randomized controlled trial included ACLF patients undergoing paracentesis between 3 and 5 L, who were randomized to receive
Paracentesis for cancer-related ascites in palliative care: An international, prospective cohort study. Paracentesis is commonly undertaken in patients with cancer-related ascites. To systematically investigate the symptomatic benefits and harms experienced by patients with cancer undergoing paracentesis using real-world data in the palliative care setting. Prospective, multisite, observational , consecutive cohort study. Benefits and harms of paracentesis were assessed between 01/07/2018 and 31/02/2021 as part of routine clinical assessments by treating clinicians at four timepoints: (T0) before paracentesis; (T1) once drainage ceased; (T2) 24 h after T1 and (T3) 28 days after T1 or next paracentesis, if sooner. Data were collected from 11 participating sites across five countries (Australia
Rates of timely paracentesis for patients admitted to hospital with cirrhosis and ascites remain low but are unaffected by the COVID-19 pandemic. For the first 6 months of the novel coronavirus-19 (COVID-19) pandemic, the hospital medicine procedure service at our center was temporarily unavailable. We assessed paracentesis rates and clinical outcomes for patients admitted with cirrhosis and ascites before and during the COVID-19 pandemic. Two hundred and twenty-four and 131 patients with cirrhosis and ascited were admitted to hospital before and during COVID-19 respectively. Approximately 50.9% and 49.6% of patients underwent a paracentesis within 24 h pre- and mid-pandemic, p = .83. No differences were observed for length-of-stay or 30-day readmissions. GI consultation was associated
Does Point-of-Care Ultrasound Change the Needle Insertion Location During Routine Bedside Paracentesis? Paracentesis is a bedside procedure to obtain ascitic fluid from the peritoneum. Point-of-care ultrasound (POCUS) improves the safety of some medical procedures. However, the evidence supporting its utility in paracentesis is limited. We aimed to assess if POCUS would yield a user-preferred site for needle insertion compared to conventional landmarking, defined as a ≥ 5 cm change in location. This was a prospective non-randomized trial comparing a POCUS-guided site to the conventional anatomic site in the same patient. Adult patients at Kingston Health Sciences Centre undergoing paracentesis were included. Physicians landmarked using conventional technique and compared this to a POCUS
Albumin for Patients With SBP or Large-Volume Paracentesis Albumin for Patients with SBP or Large-Volume Paracentesis - Emergency MedicineSkip to contentSkip to searchSkip to footerWashington University School of Medicine in St. LouisEmergency MedicineOpen MenuBackCloseMenuSearch for:SearchClose Search * WelcomeWelcome * Mission * Videos * Clinical Sites * Explore St. Louis * Our air. You check his labs and find a WBC of 13.4, baseline anemia, a creatinine of 1.2, and an INR of 1.4. His chest x-ray reveals small lung volumes without infiltrates or pulmonary edema. A bedside ultrasound reveals a large amount of ascites. You decide to perform both a therapeutic paracentesis to relieve pressure on his diaphragm and improve his respiratory complaints, and send fluid to the lab
'Rollover' abdominal paracentesis versus standard technique: protocol of a crossover randomized comparative trial. The sensitivity of single abdominal paracentesis for diagnosis of peritoneal carcinomatosis in patients with malignant ascites is 40-70%. Tumor cells shed from the peritoneum settle preferentially in certain recesses of the peritoneum. We aim to compare the standard technique of abdominal paracentesis versus a rollover technique in a randomized crossover study to assess the cytological yield in patients suspected to have peritoneal carcinomatosis. Each patient will serve as their own control and the outcome assessor (cytopathologist) will be blinded to the method of paracentesis performed. The primary objective will be to compare the tumor cell positivity between the standard