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PTU-003 Paracentesis: UK Trainees’ Practice, Experience and Attitudes
  1. C Shekhar1,
  2. A Ramakrishnan1,
  3. L C Claridge2
  1. 1Gastroenterology, University Hospital of North Staffordshire, Stoke on Trent
  2. 2Liver Unit, St James’s University Hospital, Leeds, UK

Abstract

Introduction Abdominal paracentesis is considered a relatively safe procedure1 but serious life threatening complications are known tooccur2 and practise guidelines often differ between centres. Moreover, in many European countries gastroenterologists are trained in the use of abdominal ultrasound and utilise this when inserting paracentesis catheters.

Aim :

  1. To obtain a snapshot of current UK trainee practise and experience of paracentesis and its complications.

Methods A cross sectional survey of current UK gastroenterology trainees was conducted over a 3 week period (Dec 2012-Jan 2013).

Results 88 trainees completed the survey. 75% (76/88) of respondents have more than 3 yrs’ experience in gastroenterology at registrar level. 42% (37/88) report having performed or supervised > 100 procedures and a further 42% have performed > 50 procedures. 28.7% (26/88) have witnessed serious complications; 14.9% (13/88) report significant haemorrhage requiring blood transfusion, 16.1% (14/88) have encountered bowel perforation and 9%(6/88) attribute a patient’s death to a paracentesis. Only 10.2% (9/88) of trainees routinely take informed written consent. 22.7% (20/88) state that their unit has no formal consent policy for paracentesis. 63% (48/88) of trainees exclusively use suprapubic ‘Bonnano’ catheters despite the fact that this product is unlicensed for use as a paracentesis catheter.

The majority of trainees (78.4%) estimate a failure rate requiring ultrasound guided catheter placement of < 10%. However, 23.9% (21/88) state that when this is required patients routinely wait longer than 2 days. 73.9% (65/88) report that radiology colleagues are unwilling to insert catheters in patients with INR > 1.5 without administration of fresh frozen plasma. 80.7% (71/88) of trainees believe training in abdominal ultrasonography should be part of the gastroenterology curriculum and 62.5% (55/88) feel that this would improve the safety and efficiency of paracentesis.

Conclusion The number of UK trainees reporting serious adverse events due to paracentesis is higher than expected. It is therefore of concern that few trainees are taking written consent for this procedure. The majority of trainees are still using the unlicensed ‘Bonnano’ catheter despite the availability of licenced products such as the ‘Safe-T-Centesis ‘and ‘Neo-Hydro’ drainage kits. The majority of UK gastroenterology trainees express a desire to be trained in abdominal ultrasonography and believe this would improve the safety of paracentesis.

Disclosure of Interest None Declared

References

  1. Runyon BA. Arch Intern Med. 1986 v; 146(11):2259–61.

  2. Pache I, Bilodeau M. Aliment Pharmacol Ther.2005 Mar 1; 21(5):525–9.

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