Introduction Increasing number of decompensated liver disease of varying aetiology with diuretic resistant, refractory ascites requiring paracentesis for symptomatic management.
Increasing demand upon inpatient medical beds, therefore unable to accommodate patients for paracentesis as and when necessary within acute medical take. Delay is clinical risk – potential for development of spontaneous bacterial peritonitis±variceal bleed.
Semi elective admissions for total paracentesis. Due to bed constraints admission was usually late in the day (>13.00 h), therefore overnight stays were needed in the interest of patient safety (clinical governance issue).
Methods Development of a direct access nurse led, abdominal paracentesis service, in an environment which would facilitate procedure and management of such individuals without inpatient stay.
Training – initially observed practice by consultant gastroenterologist. Competence achieved. Total >100 procedures.
Completion of the independent prescribing module has enabled the activity to be managed and led by gastroenterology nurse practitioner without need for medical cover.
Programme investigation unit (PIU) approached as highly skilled experienced medical nurses, with facility to offer a safe clinical environment for up to 8 h per day. Patients attend PIU at 9 am with drain being inserted, paracentesis to dryness with cover prior to discharge home.
Results Service has been able to accommodate 33 patients since November 2008. All of the patients drained have been discharged home without the need for overnight stay, therefore at least 66 bed days have been saved.
Conclusion Development of the advanced therapeutic role of the nurse practitioner has enabled practice to be developed with few post procedure complications. Pressures of being admitted as part of the emergency medical intake have been removed. Development of insertion criteria documentation, including standardised device throughout trust. It is believed that there is no other nurse led and managed paracentesis service in Wales
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