Introduction Liver disease is the fifth most common cause of death in England and Wales¹ and is one of the important causes of acute hospital admissions. Ascites is a common complication of Cirrhosis and patient with refractory ascites often require therapeutic paracentesis for symptomatic relief. In majority of UK hospitals, therapeutic paracentesis is done via planned admission to an acute medical bed which often causes delay waiting for a bed. In one study, the average hospital stay for therapeutic paracentesis was 5.5 days,² as they have to wait for abdominal ultrasound to mark a suitable drain site. This not only leads to patient dissatisfaction but also has significant cost implications for the Trust.

Methods Retrospect patient’s data from 2010–2013 was reviewed who attended our Ambulatory Day Unit for therapeutic paracentesis.

Results The service was set up in 2010 at the Gloucestershire Royal Hospitals with a view to perform 1–2 paracentesis weekly, which then gradually expanded to up to12–14 paracentesis week. Paracentesis was performed by an experienced and dedicated liver specialist nurse, using aseptic technique and under Human Albumin solution (100 mls of 20%) cover for every 3 litres of ascites drained. 111 patients have so far benefited from the service and 764 procedures are performed with 6 failed attempts in a single patient only with malignant ascites. There have been no complications. 63 (56.7%) patients required paracentesis once every two or more months whilst 19 (17.1%) needed weekly drains. The most number of attendances by a single patient was 62. The day case service is cost effective and has saved the Trust over £30,000 per annum. Patients love this service as it is easily accessible and has significantly reduced the waiting time for paracentesis as the service is available to patients within a few days and they are able to self-refer.

Conclusion We found the nurse led day case therapeutic paracentesis service is safe and cost effective. It is easily accessible and is liked by the patients as it gives them more control on their treatment and better continuity of their care. It has also a potential to provide training opportunities to junior doctors. We advocate setting up similar services in other NHS Trusts

References

1. The Health Survey for England 2007

2. Hill S, et al. Developing a nurse led, day-case, abdominal paracentesis service. Cancer Nursing Practice June 2013;12(5)

Disclosure of Interest None Declared.