Home relief paracentesis
a possible care practice
DOI:
https://doi.org/10.5712/rbmfc15(42)2278Keywords:
Paracentesis, Home Care Services, House Calls.Abstract
Introduction: Ascites can be defined as an accumulation of fluid in the peritoneal cavity and, in 75% of cases, is caused by cirrhosis and portal vein hypertension of different etiologies. Its treatment includes fluid restriction, diuresis and paracentesis. Relief paracentesis is a procedure that removes ascites fluid from peritoneal cavity, reduces intra-abdominal pressure and alleviate some symptoms such as dyspnea, pain, and abdominal discomfort. It is a simple and safe technique that can be performed in a hospital or outpatient setting. The expansion of home care services in our country has enabled the completion of more complex procedures at home and may contribute to the welfare of outpatients in palliative care. Objective: Describe the profile of outpatients undergoing relief paracentesis. Methods: Cross-sectional study, including consecutive patients of a public home care service who underwent home relief paracentesis between 2009 and 2017. Data were collected from medical records and the Software Statistical Package for the Social Sciences v. 18.0 (SPSS) was used for data analysis. Results: Sample consisted of 15 out patients. We observed an average of 8.1 (3-15) in Charlson Comorbidity Index and neoplasms were the main cause of ascites (80.2%). 48 relief paracenteses were performed during the period and six patients presented clinical symptomatology requiring unplanned home visit. Concerning complications of paracentesis procedure, only one patient had bleeding at the puncture site. All above situations were handled at home. Regarding outcomes of care, 53% of patients required hospital readmission because of clinical worsening. Conclusions: Home relief paracentesis is a safe practice and can reduce unnecessary procedures at an emergency room. It is important that professionals are properly trained to perform the procedure with routine and technique established by a home care service.
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(1) Pericleous M, Sarnowski A, Moore A, Fijten R, Zaman M. The clinical management of abdominal ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: a review of current guidelines and recommendations. Eur J Gastroenterol Hepatol. 2016 Mar;28(3):e10-8. DOI: https://doi.org/10.1097/MEG.0000000000000548
(2) Runyon BA. Diagnostic and therapeutic abdominal paracentesis. UpToDate [Internet]. 2019 Nov; [acesso em 2019 dezembro 10 ]. Disponível em: https://www.uptodate.com/contents/diagnostic-and-therapeutic-abdominal-paracentesis#H337673819
(3) Shlamovitz GZ, Shah NR. Paracentesis technique. Medscape [Internet]. 2012 Apr; [acesso em 2019 dezembro 10]. Disponível em: https://emedicine.medscape.com/article/80944-technique
(4) Solla NS, Manzanares PMS, Pollo DR. Técnicas importantes en el domicilio: el maletín domiciliario, la vía subcutánea y la paracentesis evacuadora. AMF. 2014 Mai;10(5):294-300.
(5) Débdi MB, Chaves VM, Rodríguez CC, Muñoz JM. Paracentesis evacuadora domiciliaria en cuidados paliativos realizada por profesionales de atención primaria. Presentación de un caso. Semergen. 2013;39(3):161-4.
(6) Pilatti P, Lagni VB, Picasso MC, Puma K, Mestriner RJ, Oliveira DM, et al. Cuidados paliativos oncológicos em um serviço público de atenção domiciliar. Rev Bras Med Fam Comunidade. 2017;12(39):1-10. DOI: https://doi.org/10.5712/rbmfc12(39)1339
(7) Zama IM, Edgar M. Management of symptomatic ascites in hospice patients with paracentesis: a case series report. Am J Hosp Palliat Care. 2012 Ago;29(5):405-8. DOI: https://doi.org/10.1177/1049909111420130
(8) Runyon BA. Ascites in adults with cirrhosis: diuretic-resistant ascites. UpToDate [Internet]. 2019 Fev; [acesso em 2019 dezembro 10]. Disponível em: https://www.uptodate.com/contents/ascites-in-adults-with-cirrhosis-diuretic-resistant-ascites
(9) Bernardi M, Caraceni P, Navickis RJ, Wilkes MM, et al. Albumin infusion in patients undergoing large volume paracentesis: a metaanalysis of randomized trials. Hepatology. 2012 Abr;55(4):1172-81. DOI: https://doi.org/10.1002/hep.24786
(10) Sharzehi K, Jain V, Naveed A, Schreibman I. Hemorrhagic complications of paracentesis: a systematic review of the literature. Gastroenterol Res Pract. 2014;2014:985141. DOI: https://doi.org/10.1155/2014/985141
(11) Gottardi A, Thévenot T, Spahr L, Morard I, Bresson-Hadni S, Torres F, et al. Risk of complications after abdominal paracentesis in cirrhotic patients: a prospective study. Clin Gastroenterol Hepatol. 2009 Ago;7(8):906-9. DOI: https://doi.org/10.1016/j.cgh.2009.05.004
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