This post covers, from CoreIM and the American Thoracic Society YouTube Channel:
- Mind The Gap on Admission Paracentesis, Part 1
Posted: November 1, 2017
By: Dr. Steve Liu and Dr. Janine Knudsen, podcast from CoreIM - Mind the Gap on Abdominal Paracentesis, Part 2
Posted: November 29, 2017 from CoreIM
By: Dr. Steve Liu and Dr. Janine Knudsen, podcast from CoreIM - Ultrasound for Paracentesis — BAVLS May 16, 2017, YouTube video from the American Thoracic Society [This link is to the ATS home page].
Here are excerpts from Mind The Gap on Admission Paracentesis, Part 1:
Show Notes
- AASLD and European Association for the Study of the Liver guidelines recommend patients with cirrhosis and ascites admitted to the hospital should undergo a diagnostic abdominal paracentesis.
- In a prospective observational trial, physician clinical impression had a sensitivity of 76% and specificity of 34% for spontaneous bacterial peritonitis on admission
- Faculty tended to be more sensitive than residents, but not statistically significant.
- Don’t forget about asymptomatic SBP!
- Delayed paracentesis is associated with increased in-hospital mortality in patients with SBP comparing early paracentesis within 12 hours of admission vs. delayed between 12- 72 hours from admission.
- This corresponded to an increase in mortality of 3.3% for every hour delayed.
Here are excerpts from Mind the Gap on Abdominal Paracentesis, Part 2:
Take Away Points
- It has been shown in cirrhotic with INRs greater than 1.5 and platelets less than 50, there were minimal complication rates after paracentesis.
- Platelet transfusion prior to paracentesis is grade III recommendation. It was neither useful nor effective, and it can even be harmful.
- General internists had the similar safety outcomes as IR specialists and gave fewer platelets and FFP transfusions.
- Sending paracentesis fluid in blood culture bottles increased yield.
The YouTube video, Ultrasound for Paracentesis — BAVLS:, from the American Thoracic Society should be watched in its entirety as there are many valuable points. Ultrasound should be used if available as it makes paracentesis safer.