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Central venous pressure catheter for large-volume paracentesis in refractory ascites

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Abstract

Background and Aims

About 10 % of cirrhotic patients are unresponsive to sodium restriction and diuretics and develop refractory ascites. Such patients usually require recurrent large-volume paracentesis and lots of hospital admissions. Hereby, we introduce a method applying a central vein (CV) catheter for large-volume paracentesis in patients with refractory ascites in up to 4 days associated with sodium restriction and high dose of diuretics.

Methods

Non-tunneled triple lumen CV catheter was used to drain the ascites fluid of 30 cirrhotic patients. After precise percussion, the point of highest fluid accumulation was marked for puncture. Then, the skin and subcutaneous tissue were anesthetized. CV catheter set guide wire was entered into the peritoneal cavity and the dilator of the CV catheter set was passed through the guide wire and extracted after some rotations around its insertion site on the skin. The catheter was passed over the guide wire and the guide wire was extracted gradually from one of the lumens and fixed to the skin.

Results

Nineteen males and 11 females with mean (±SD) age of 59.4 ± 11.7 years old underwent the procedure. A minimum of 9 and maximum of 29 L (12 ± 6.6 L) ascites fluid drained during a minimum of 2 and maximum of 5 days of hospital stay. All catheters were patent during the drainage. None of the patients developed hemodynamic instability. Number of re-hospitalizations for paracentesis was 1.9 times during the following year. No complication occurred.

Conclusions

This technique is a simple noninvasive method that can be performed in the endoscopy unit or even at the patient’s bedside and may reduce the need for repeated admissions.

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Conflict of interest

SA, ST, HN, MN, and AAl declare that they have no conflict of interest.

Ethics statement

The authors declare that the study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning Human and Animal Rights, and that the authors followed the policy concerning Informed Consent as shown on Springer.com.

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Authors and Affiliations

  1. Colorectal Research Center, Rasool-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

    Shahram Agah, Hajar Nikbakht & Mehrdokht Najafi

  2. Internal Medicine, Rasool-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

    Sahar Tavakoli

  3. Erfan Clinic, Tehran, Iran

    Abdolreza Al-agha

Authors
  1. Shahram Agah
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  2. Sahar Tavakoli
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  3. Hajar Nikbakht
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  4. Mehrdokht Najafi
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  5. Abdolreza Al-agha
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Corresponding author

Correspondence to Shahram Agah.

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Agah, S., Tavakoli, S., Nikbakht, H. et al. Central venous pressure catheter for large-volume paracentesis in refractory ascites. Indian J Gastroenterol 33, 310–315 (2014). https://doi.org/10.1007/s12664-014-0448-0

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  • DOI: https://doi.org/10.1007/s12664-014-0448-0

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