Continuous peritoneal drainage of large-volume ascites

David H. Van Thiel*, Christopher M. Moore, Moises Garcia, Magdalena George, Abdul Nadir

*Corresponding author for this work

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: With the increasing population of individuals with cirrhosis, many of whom are not liver transplant candidates, large volume paracentesis as a medical therapy for ascites resistant to diuretic therapy has become increasingly utilized. Aim: To determine the safety and efficacy of continuous peritoneal drainage of large-volume ascites in Child Class-C cirrhosis. Subjects with no current clinical or laboratory findings of spontaneous bacterial ascites were studied. Each had a complete medical evaluation to document the etiology and severity of their liver disease as well as the identification of any confounding medical illness. A triple-phase abdominal CT of the abdomen was obtained in each individual to rule out any hepatoma. Upon completion of the above, a pericardiocentesis catheter was placed in the abdomen using the Seldinger technique and the ascites was drained continuously (to gravity) until no additional ascitic fluid could be removed or the total time of drainage was 72 h. The patient's weight, volume of ascitic fluid removed, ascitic fluid cell counts, ascitic fluid cultures, complete blood count and comprehensive metabolic profile were obtained immediately before and after the peritoneal catheter was removed. Results: HCV cirrhosis accounted for 12 cases and alcoholic liver disease accounted for 8 cases (half the total of 40 cases), with 6 other diseases accounting for the remaining half. The ascitic fluid was drained continuously for 2.5 ± 0.08 days, with a removal of 13.3 ± 0.5 l of ascitic fluid. No clinically significant change in the serum creatinine or ascitic fluid cells count occurred as a result of the procedure. The adverse effects of the procedure were minimal. 63% of the patients experienced some mild discomfort at the catheter insertion site, or local abdominal pain just prior to the removal of the catheter. Two patients developed a small abdominal wall hematoma that required no therapy. No patients experienced peritoneal hemorrhage, infection or renal dysfunction. Conclusion: (1) Continuous large-volume peritoneal drainage by gravity is safe and effective; (2) if the procedure is limited 72 h, no cases of ascitic fluid contamination/infection occur; and (3) it reduces the time between subsequent paracentesis based upon historical data.

Original languageEnglish (US)
Pages (from-to)2723-2727
Number of pages5
JournalDigestive diseases and sciences
Volume56
Issue number9
DOIs
StatePublished - Sep 1 2011

Fingerprint

Ascitic Fluid
Ascites
Drainage
Catheters
Paracentesis
Fibrosis
Gravitation
Abdomen
Cell Count
Pericardiocentesis
Alcoholic Liver Diseases
Metabolome
Blood Cell Count
Abdominal Wall
Infection
Diuretics
Hematoma
Abdominal Pain
Liver Diseases
Hepatocellular Carcinoma

Keywords

  • Anasarca
  • Ascites
  • Cirrhosis
  • Hyponatremia
  • Portal hypertension
  • Renal dysfunction

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Van Thiel, David H. ; Moore, Christopher M. ; Garcia, Moises ; George, Magdalena ; Nadir, Abdul. / Continuous peritoneal drainage of large-volume ascites. In: Digestive diseases and sciences. 2011 ; Vol. 56, No. 9. pp. 2723-2727.
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abstract = "Background: With the increasing population of individuals with cirrhosis, many of whom are not liver transplant candidates, large volume paracentesis as a medical therapy for ascites resistant to diuretic therapy has become increasingly utilized. Aim: To determine the safety and efficacy of continuous peritoneal drainage of large-volume ascites in Child Class-C cirrhosis. Subjects with no current clinical or laboratory findings of spontaneous bacterial ascites were studied. Each had a complete medical evaluation to document the etiology and severity of their liver disease as well as the identification of any confounding medical illness. A triple-phase abdominal CT of the abdomen was obtained in each individual to rule out any hepatoma. Upon completion of the above, a pericardiocentesis catheter was placed in the abdomen using the Seldinger technique and the ascites was drained continuously (to gravity) until no additional ascitic fluid could be removed or the total time of drainage was 72 h. The patient's weight, volume of ascitic fluid removed, ascitic fluid cell counts, ascitic fluid cultures, complete blood count and comprehensive metabolic profile were obtained immediately before and after the peritoneal catheter was removed. Results: HCV cirrhosis accounted for 12 cases and alcoholic liver disease accounted for 8 cases (half the total of 40 cases), with 6 other diseases accounting for the remaining half. The ascitic fluid was drained continuously for 2.5 ± 0.08 days, with a removal of 13.3 ± 0.5 l of ascitic fluid. No clinically significant change in the serum creatinine or ascitic fluid cells count occurred as a result of the procedure. The adverse effects of the procedure were minimal. 63{\%} of the patients experienced some mild discomfort at the catheter insertion site, or local abdominal pain just prior to the removal of the catheter. Two patients developed a small abdominal wall hematoma that required no therapy. No patients experienced peritoneal hemorrhage, infection or renal dysfunction. Conclusion: (1) Continuous large-volume peritoneal drainage by gravity is safe and effective; (2) if the procedure is limited 72 h, no cases of ascitic fluid contamination/infection occur; and (3) it reduces the time between subsequent paracentesis based upon historical data.",
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Continuous peritoneal drainage of large-volume ascites. / Van Thiel, David H.; Moore, Christopher M.; Garcia, Moises; George, Magdalena; Nadir, Abdul.

In: Digestive diseases and sciences, Vol. 56, No. 9, 01.09.2011, p. 2723-2727.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Continuous peritoneal drainage of large-volume ascites

AU - Van Thiel, David H.

AU - Moore, Christopher M.

AU - Garcia, Moises

AU - George, Magdalena

AU - Nadir, Abdul

PY - 2011/9/1

Y1 - 2011/9/1

N2 - Background: With the increasing population of individuals with cirrhosis, many of whom are not liver transplant candidates, large volume paracentesis as a medical therapy for ascites resistant to diuretic therapy has become increasingly utilized. Aim: To determine the safety and efficacy of continuous peritoneal drainage of large-volume ascites in Child Class-C cirrhosis. Subjects with no current clinical or laboratory findings of spontaneous bacterial ascites were studied. Each had a complete medical evaluation to document the etiology and severity of their liver disease as well as the identification of any confounding medical illness. A triple-phase abdominal CT of the abdomen was obtained in each individual to rule out any hepatoma. Upon completion of the above, a pericardiocentesis catheter was placed in the abdomen using the Seldinger technique and the ascites was drained continuously (to gravity) until no additional ascitic fluid could be removed or the total time of drainage was 72 h. The patient's weight, volume of ascitic fluid removed, ascitic fluid cell counts, ascitic fluid cultures, complete blood count and comprehensive metabolic profile were obtained immediately before and after the peritoneal catheter was removed. Results: HCV cirrhosis accounted for 12 cases and alcoholic liver disease accounted for 8 cases (half the total of 40 cases), with 6 other diseases accounting for the remaining half. The ascitic fluid was drained continuously for 2.5 ± 0.08 days, with a removal of 13.3 ± 0.5 l of ascitic fluid. No clinically significant change in the serum creatinine or ascitic fluid cells count occurred as a result of the procedure. The adverse effects of the procedure were minimal. 63% of the patients experienced some mild discomfort at the catheter insertion site, or local abdominal pain just prior to the removal of the catheter. Two patients developed a small abdominal wall hematoma that required no therapy. No patients experienced peritoneal hemorrhage, infection or renal dysfunction. Conclusion: (1) Continuous large-volume peritoneal drainage by gravity is safe and effective; (2) if the procedure is limited 72 h, no cases of ascitic fluid contamination/infection occur; and (3) it reduces the time between subsequent paracentesis based upon historical data.

AB - Background: With the increasing population of individuals with cirrhosis, many of whom are not liver transplant candidates, large volume paracentesis as a medical therapy for ascites resistant to diuretic therapy has become increasingly utilized. Aim: To determine the safety and efficacy of continuous peritoneal drainage of large-volume ascites in Child Class-C cirrhosis. Subjects with no current clinical or laboratory findings of spontaneous bacterial ascites were studied. Each had a complete medical evaluation to document the etiology and severity of their liver disease as well as the identification of any confounding medical illness. A triple-phase abdominal CT of the abdomen was obtained in each individual to rule out any hepatoma. Upon completion of the above, a pericardiocentesis catheter was placed in the abdomen using the Seldinger technique and the ascites was drained continuously (to gravity) until no additional ascitic fluid could be removed or the total time of drainage was 72 h. The patient's weight, volume of ascitic fluid removed, ascitic fluid cell counts, ascitic fluid cultures, complete blood count and comprehensive metabolic profile were obtained immediately before and after the peritoneal catheter was removed. Results: HCV cirrhosis accounted for 12 cases and alcoholic liver disease accounted for 8 cases (half the total of 40 cases), with 6 other diseases accounting for the remaining half. The ascitic fluid was drained continuously for 2.5 ± 0.08 days, with a removal of 13.3 ± 0.5 l of ascitic fluid. No clinically significant change in the serum creatinine or ascitic fluid cells count occurred as a result of the procedure. The adverse effects of the procedure were minimal. 63% of the patients experienced some mild discomfort at the catheter insertion site, or local abdominal pain just prior to the removal of the catheter. Two patients developed a small abdominal wall hematoma that required no therapy. No patients experienced peritoneal hemorrhage, infection or renal dysfunction. Conclusion: (1) Continuous large-volume peritoneal drainage by gravity is safe and effective; (2) if the procedure is limited 72 h, no cases of ascitic fluid contamination/infection occur; and (3) it reduces the time between subsequent paracentesis based upon historical data.

KW - Anasarca

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KW - Cirrhosis

KW - Hyponatremia

KW - Portal hypertension

KW - Renal dysfunction

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