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PTH-068 Development of nurse led paracentesis service
  1. K J Caddick,
  2. A D Dhanda,
  3. P L Collins,
  4. F H Gordon,
  5. A C McCune,
  6. A J Portal
  1. Department of Hepatology, University Hospitals Bristol NHS Trust, Bristol, UK

Abstract

Introduction Patients (Pts) with chronic liver disease who have refractory or diuretic resistant ascites require regular paracentesis. Previously this resulted in urgent admission via the medical take leading to inconvenience for the patient and additional work for the admitting team. Pts admitted for paracentesis had an average length of stay of 6.4 days. The Hepatology Nurse Specialist (HCNS)-lead outpatient (OP) paracentesis service was initiated in November 2007 which intended to reduce the frequency of hospital admissions for ascites drainage and the length of stay as an inpatient. The service aims to improve the Pts' quality of life and to reduce healthcare associated infection. We report the outcome of the first 2 years of the service.

Methods Pts are referred to the HCNS from the Hepatology ward, or consultant clinics. The HCNS initiates regular Pt contact to monitor blood tests and weight. On admission HCNS reviews the Pt and their blood results. The amount of ascites drained is recorded ensuring frequency of drainage is optimised. It is possible for two-three Pts to access OP paracentesis service each week, which is planned to fit around Pts' commitments. Following drainage HCNS remains in contact with Pts to establishing a pattern of drainage planned 2–3 months in advance giving Pts control over admissions, preventing adhoc admissions via A&E.

Results 18 Patients on the hepatology OP paracentesis database; 16 analysed (2 unavailable) 95 paracentesis admissions over 18 mths since service initiation; 73.6% Pts used the outpatient paracentesis service and remained an inpatient for 8 h; 26.3% were admitted as inpatients due to decompensation. The mean time interval between drains was 22 days. Average 8500 mls drained per episode.

Disease progression required some hospital admissions, as Pts became more unwell requiring interventions or palliation not offered by the OP paracentesis service or community care. Adhoc emergency admissions required longer admission and caused distress. Planned paracentesis allowed Pts to have control of their admissions. Pts are at lower risk of hospital-acquired infection. Pts and families felt supported by the service, being rapidly able to access assessment and assistance from HCNS. 70 admissions were avoided by having a daycase procedure. Admissions to the ward increased with disease progression.

Conclusion Our nurse-led OP paracentesis service avoided 70 hospital admissions over a 2-year period and reduced Pts stay in hospital from an average of 6.4 days to 8 h. Regular large volume paracentesis was successful. Planned admissions are more acceptable for both Pts and staff. Service flexibility gives the Pts more control of their admissions and improves their quality of life.

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