What is the duration of ascites drainage if ascitic fluid is still present?

From the Guidelines

The duration of ascites drainage should be approximately every 2 weeks, as this frequency has been shown to effectively control ascites in patients with cirrhosis, according to the management guidelines outlined by RUNYON 1. When considering the duration of ascites drainage, several factors come into play, including the amount of fluid present, the patient's overall condition, and their response to treatment.

• The goal of ascites drainage is to remove excess fluid while minimizing the risk of complications such as hypotension or kidney injury.
• The amount of fluid removed during each session can vary, but most procedures aim to remove 4-6 liters of fluid at a time, as noted in the study by RUNYON 1.
• The frequency of paracentesis provides insight into the patient's degree of compliance with their diet, and patients requiring paracenteses of approximately 10 L more frequently than every 2 weeks may not be complying with their diet, as suggested by the study 1.
• For patients with recurrent ascites, a tunneled catheter may be left in place for intermittent drainage at home, with each session lasting about 30-60 minutes.
• It is essential to monitor patients during and after drainage for signs of discomfort, dizziness, or low blood pressure, as these may indicate that the drainage should be slowed or stopped, and to consider liver transplantation as a treatment option for patients with refractory ascites, as their mortality rate is high, with 50% dying within 6 months and 75% dying within 1 year, as stated in the study 1.

From the Research

Duration of Ascites Drainage

The duration of ascites drainage can vary depending on the method used and the individual patient's condition.

• Repeated large volume paracentesis may be performed every 10-14 days until disappearance of ascites 2.
• Total paracentesis, or complete mobilization of ascites in one session, can also be effective 2.
• For patients with refractory ascites, a permanent-tunneled peritoneal catheter can be used for continuous drainage, with the volume of daily ascites removal remaining stable at around 2 liters per day 3.
• In patients with advanced cancer, a permanent peritoneal catheter can be used for continuous drainage, with a mean drained volume of 8,499 ml during admission and a mean survival of 38.9 days 4.
• Long-term abdominal drains (LTADs) can be used for palliative care in patients with untreatable ascites due to advanced cirrhosis, allowing for ascites management outside of a hospital setting 5.
• The Pleurx tunneled catheter can provide effective palliation for patients with malignant ascites, with a mean catheter survival of 70 days 6.

Factors Affecting Drainage Duration

Several factors can affect the duration of ascites drainage, including:

• The underlying cause of the ascites (e.g. cirrhosis, cancer) 2, 3, 4, 5, 6
• The patient's overall health and prognosis 3, 4, 5
• The type of drainage method used (e.g. paracentesis, catheter) 2, 3, 4, 5, 6
• The frequency of drainage 2, 3, 4, 5