The aim of large volume paracentesis is to provide symptomatic relief of symptoms associated with large volumes of fluid (ascites).
What is ascites?
Ascites is an accumulation of fluid in the abdomen. Although it is normal to have a small amount of this fluid in your abdomen, if there is an imbalance in the creation and absorption of this fluid this may result in a larger amount of fluid accumulating. There are a number of reasons why this balance may change and your doctor or nurse should have explained why this has occurred for you. In your case it is due to the natural progression of your liver cirrhosis.
Problems Associated with Ascites
When a large amount of fluid builds up it can affect your appetite, cause nausea and vomiting, indigestion or make you feel short of breath. It may also make you less mobile or feel unsteady on your feet.
Managing Ascites
Although this excess fluid can sometimes be managed with medications, some patients need to have it removed via a procedure. This is performed on the ward or occasionally in the x-ray department. This procedure involves draining the fluid off the abdomen – an ascitic drain.
Understanding the Procedure
The main aim of this procedure is to relieve some of the symptoms you may have been experiencing as a result of the excess fluid.
This procedure can be carried out as a day case procedure or during your hospital stay if needed. It will be performed by a specialist nurse or a doctor. You may have to have your blood tests repeated before the drain can be inserted.
Before they start the procedure they will need to ensure that you understand the risks and benefits of having it done and that you have given your consent.
Do not take your water tablets on the day you are attending to have your abdomen drained, but do start them again the day after. This will be further explained when you arrive.
If you decide you do not want to have your drain on the day please contact the PIU department as soon as possible informing them of your decision and rebook an alternative date. Please be mindful that by not having this procedure, your symptoms could become worse. If you have any other special requirements please don’t hesitate to contact the PIU department on 0191 445 2824 and have a discussion with a member of staff to see if they can help.
If you need more advice or would just like to have a chat about your procedure please contact the liver team on 0191 4453935.
The Procedure
You will be asked to lie on your back so that you can be examined to allow the staff member who is inserting the drain to find a suitable site. They will clean the area carefully and then insert some local anaesthetic under the skin using a small needle. When the area has been numbed they will insert the drain and attach a drain bag to collect the fluid. You may need to have some protein fluids via a drip in your arm while the drain is in. The drain will stay in for a maximum of six hours. When it is removed a clean dressing will be placed over the site. If fluid continues to leak, you may need a small stitch inserted over the hole.
Providing the drain was inserted as a day case procedure and your observations are stable, you can be discharged home. If there are concerns regarding the drain or your observations, you may need to stay in overnight.
If you have any questions regarding anything raised in this leaflet, please discuss with your doctor or nurse before the drain is inserted.
Are there any risks?
Risks for this procedure include:
- Pain
- Bleeding
- Infection
- Fluid leak
- Damage to internal structures such as the bowel
Although these complications do not occur frequently they can be very serious and life threatening if they do occur. A life-threatening complication may require additional procedures (such as surgery), however due to your underlying illness an operation may not always be appropriate.
References
Adapted from Batchelor S, Panter S & Saksena S (May 2016) Regional Liver network recommendations on large volume paracentesis.