From the Guidelines
Large volume paracentesis (LVP) is the treatment of choice for managing patients with grade 3 ascites, involving the removal of large volumes of ascitic fluid.
Key Points
- LVP is more effective than diuretics in managing grade 3 ascites and significantly shortens the duration of hospital stay 1.
- The administration of albumin is the most effective method to prevent circulatory dysfunction after LVP, and it is recommended to administer it slowly at the end of the procedure 1.
- LVP is a safe procedure with a low risk of local complications, such as hemorrhage or bowel perforation, and can be performed under strict sterile conditions using disposable sterile materials 1.
- Diuretic treatment is required after LVP to prevent the re-accumulation of ascites, as LVP does not address the underlying cause of the condition, namely renal sodium and water retention 1.
- LVP should be considered in conjunction with the assessment of suitability for liver transplantation, especially in cases of refractory ascites 1.
Important Considerations
- The removal of large volumes of ascitic fluid can lead to circulatory dysfunction, characterized by a reduction of effective blood volume, known as post-paracentesis circulatory dysfunction (PPCD) 1.
- The development of PPCD is associated with rapid re-accumulation of ascites, increased portal pressure, and shortened survival 1.
- Alternative plasma volume expanders, such as dextran-70 and polygeline, may be used in certain situations, but albumin is the most effective and recommended option, especially when more than 5 L of ascites are removed 1.
From the Research
Definition and Purpose of Large Volume Paracentesis
- Large volume paracentesis is a medical procedure that involves the removal of a large amount of fluid from the abdominal cavity, often used to treat refractory ascites in patients with cirrhosis or other liver diseases 2, 3, 4.
- The purpose of large volume paracentesis is to relieve symptoms such as abdominal distention, shortness of breath, and discomfort, and to improve the patient's quality of life 5, 6.
Safety and Efficacy of Large Volume Paracentesis
- Studies have shown that large volume paracentesis is a safe and effective procedure, with a low risk of complications such as bleeding or infection 2, 3, 6.
- The procedure can be performed at the bedside by trained healthcare professionals, and can be repeated as needed to manage refractory ascites 5, 4.
- Large volume paracentesis has been shown to be effective in reducing symptoms and improving patient outcomes, including reducing the need for diuretics and hospitalization 3, 4.
Indications and Contraindications for Large Volume Paracentesis
- Large volume paracentesis is typically indicated for patients with refractory ascites, which is ascites that does not respond to diuretic therapy or other treatments 2, 3, 4.
- The procedure may be contraindicated in patients with certain medical conditions, such as spontaneous bacterial peritonitis (SBP), although some studies suggest that it can be safely performed in selected patients with SBP 6.
- The decision to perform large volume paracentesis should be made on a case-by-case basis, taking into account the individual patient's medical history, condition, and needs 2, 3, 4.