Diagnostic Paracentesis in Cirrhotic Ascites From Core IM And The American Thoracic Society

Posted on November 11, 2019 by Tom Wade MD

This post covers, from CoreIM and the American Thoracic Society YouTube Channel:

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.

 

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