Introduction Ascites is a common consequence of cancer, occurring in 15–50% of patients, and causes symptoms such as abdominal discomfort, anorexia, nausea and a reduced quality of life. Therapeutic paracentesis is the most often utilised and the most effective treatment for malignant ascites. It can improve the patient’s symptoms and quality of life, and has a low risk of complications. The aim of this study was to assess the safety and efficacy of day case paracentesis in the context of malignant ascites.
Methods We performed a retrospective analysis of patients with malignant ascites admitted as a day case to our Ambulatory Care Unit (ACU) for therapeutic paracentesis. Drains were placed without ultrasound guidance by doctors experienced in the procedure. Drains were left in situ for a maximum of 6 h. Albumin or fluids were not given. Data on blood pressure and heart rate before and after the procedure, the volume of fluid removed, duration of stay, any complications and any fluids given, were recorded. Data such as age, albumin levels, having chemotherapy at that time and if they are still alive were collected for all the patients.
Results A total of 20 ascitic drains, performed in 9 patients, were identified. Of these, 19 drains were performed successfully as day-case procedures at ambulatory care unit (ACU).
Mean age of patients was 75 years (range 45–85 years). All patients had cancer of gastrointestinal origin. Five patients were having chemotherapy at the time of the procedure. The average albumin was 31.3 g/L (range 23–41).
The mean volume of ascites drained was 8.3 L (range 4.0–14.8 L).
There were no significant changes in either mean arterial pressure or heart rate before and after paracentesis. Heart rate: before 82 ± 18 bpm, after 82 ± 13 bpm (p = 0.95). Mean arterial pressure: before 91 ± 10 mmHg and after 84 ± 11 mmHg (P = 0.07).
The maximum time of staying in ACU was 8.5 h (mean time <7 h). Six patients have since died from cancer related deaths.
There was one failed paracentesis; this patient subsequently underwent uncomplicated ultrasound guided placement. One drain was delayed by 48 h due to neutropenia. There were no serious complications and no patients required hospital admission. One minor complication was reported (skin haematoma) and one patient required intravenous fluids.
Conclusion Day case paracentesis is both safe and effective in the management of malignant ascites. It is not necessary to routinely replace fluid or albumin during the procedure. This approach can avoid unnecessary hospital admissions and provides rapid improvement in patient’s symptoms and patient quality of life.
Disclosure of Interest None Declared.
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