A quick and safe way to drain this fluid without tying up resources at the bedside.

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ACEP Now: Vol 33 – No 07 – July 2014

 

A 55-year-old male with severe ascites secondary to chronic cirrhotic liver disease presents to the emergency department for shortness of breath secondary to fluid accumulation and abdominal distention. He routinely visits the ED for therapeutic paracentesis, likely due to poor follow-up as a result of being uninsured. As usual, the department is very busy, and you have many critical patients who require your attention. Is there a quick and safe way to drain this fluid without tying up resources at the bedside?

You can use wall suction and several suction canisters to create a closed continuous drainage system for removing large amounts of ascitic fluid during a paracentesis.

Often, chronic liver failure patients will present to the ED for symptomatic drainage of their ascites. Many of these patients need to have several liters drained, and this can become time-consuming in a busy emergency department. This technique allows for a quick, clean, and easy way to continuously remove this ascitic fluid.

Patient Selection

This technique may be applicable for stable patients with a large amount of ascites, usually chronic liver failure patients, who regularly have a significant amount of ascitic fluid removed via paracentesis.

This may not be appropriate for patients with a small amount of ascites or unstable patients.

Cautions and Complications

Complications of paracentesis are infrequently encountered and have been reported as low as 1.6 percent in a 2009 study.¹ Most of the complications encountered, such as bleeding from the puncture site or a persistent leak of fluid from the puncture site, are considered minor. Major complications are rarely encountered, and according to newer studies on paracentesis safety, coagulopathy does not seem to increase the risk of complications from a paracentesis.² It is imperative that all patients undergoing a paracentesis are placed on a cardiac monitor and IV access is established prior to starting the procedure. Fluid shifts from ascitic fluid removal render the patients at risk for post procedure hypotension, electrolyte abnormalities (most notably hyponatremia), and third spacing leading to the most feared complication, pulmonary edema.³ Cirrhotic liver disease is linked to hepatopulmonary syndrome and cirrhotic cardiomyopathy, placing patients at risk of pulmonary edema as a result of fluid shifts if a large volume of fluid is removed during paracentesis.⁴ Recommended limits for total fluid removal vary depending on the source, but the consensus among guidelines is 5–6 liters without the need for volume expanders to lessen chances of major complications.

Equipment Needed

• Wall suction unit
  

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