Performing Large Volume Paracentesis as an Outpatient Procedure

Main Category: GastroIntestinal / Gastroenterology
Article Date: 18 Aug 2004 - 17:00 PDT

email to a friend   printer friendly   opinions  

A study examines the safety and efficiency of large-volume paracentesis performed by nonphysician health care providers in an outpatient setting.

Large-volume paracentesis is a treatment used to remove excess fluid in the abdominal cavity resulting from such conditions as cirrhosis of the liver or cardiac failure. It is normally performed as an inpatient procedure due to possible complications, which may include infection, bleeding, and bowel perforation.

In a study led by Catherine M. Grabau at the Division of Gastroenterology and Hepatology and Internal Medicine at the Mayo Clinic in Rochester, Minnesota, and published in the August issue of Hepatology, gastrointestinal endoscopy assistants performed large-volume paracenteses on outpatients in order to determine how many procedures were required to develop competence and the amount of time needed to perform each procedure.

Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD), published by John Wiley & Sons, Inc. is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/hepatology.

The gastrointestinal endoscopy assistants, all of whom were licensed practical nurses, performed 1,100 large-volume paracenteses in 628 patients during the period between June 1994 and June 2001. During training, the supervising physician discussed the procedure in depth with the trainee and performed the first paracentesis, with the trainee assisting. The next two procedures were performed by the gastrointestinal endoscopy assistant with the physician assisting, and the next four to six procedures were done by the assistant independently, under the physician's observation.

The number of independent procedures performed by the trainee before the supervising physician was comfortable with the level of skill ranged from three to seven. In the 23 patients in which the gastrointestinal endoscopy assistants determined that paracentesis was not feasible, the supervising physician agreed with the assessment in all cases.

The study also examined the risk of possible complications, in particular whether the risk of bleeding was associated with thrombocytopenia (reduced platelet count) or prolonged prothrombin (clotting) time. None of the patients in the study experienced significant bleeding or complications, even those whose platelet count was significantly below normal range and those with prolonged prothrombin time.

The authors conclude that paracentesis performed in an outpatient setting by gastrointestinal endoscopy assistants is safe and efficient, and can usually be accomplished in two hours. The major benefit is a significant saving in physician time (limited to a maximum of 10 supervised procedures) with no increased risk to the patient.

Further, since the guidelines of the Joint Commission on Accreditation of Healthcare Organizations recommend discontinuing the practice of having gastrointestinal endoscopy assistant carry out the procedure, the authors suggest that the guidelines may need to be readdressed.

Article: "Performance Standards for Therapeutic Abdominal Paracentesis," Catherine M. Grabau, Sharon F. Crago, Linda K. Hoff, Julie A. Simon, Cheryl A Melton, Beverly J. Ott, Patrick S. Kamath, Hepatology; August 2004; 40:2; pp. 484-488.

About John Wiley & Sons, Inc.

Founded in 1807, John Wiley & Sons, Inc., provides must-have content and services to customers worldwide. Our core businesses include scientific, technical, and medical journals, encyclopedias, books, and online products and services; professional and consumer books and subscription services; and educational materials for undergraduate and graduate students and lifelong learners. Wiley has publishing, marketing, and distribution centers in the United States, Canada, Europe, Asia, and Australia. The company is listed on the New York Stock Exchange under the symbols JWa and JWb. Wiley's Internet site can be accessed at http://www.wiley.com.

HEPATOLOGY
Research News Alert
John Wiley & Sons, Inc.
August 18, 2004
For Immediate Release
http://www.interscience.wiley.com/journal/hepatology

Contact: David Greenberg
(201) 748-6484
dgreenbe@wiley.com

• Additional
• References
• Citations