Home-based paracentesis: a case series

Abstract

Introduction: Paracentesis, a procedure in which free fluid is removed from the abdominal cavity through a needle puncture, is the primary treatment for large-volume and refractory ascites. Furthermore, there is a consensus in the literature that this procedure has low complication rates when correctly indicated and performed by a trained professional using the appropriate technique. However, there is few data in the literature on the performance of paracentesis at home, despite documents from the Ministry of Health indicating that it is feasible. Objective: To describe and analyze a case series of paracentesis procedures performed at home within a Home Care Service, as well as the profile of patients, admissions, and procedural complications. Methods: A cross-sectional, documentary, and retrospective study was conducted, reviewing medical records of patients admitted to a Home Care Service between 2008 and 2022. All patients who underwent paracentesis at home during this period were sequentially included. The Statistical Package for the Social Sciences software was used for descriptive and statistical nanalysis. Results: The sample consisted of 47 patients, who were admitted to the Home Care Service o 63 occasions and underwent 468 paracenteses at home. The mean age was 63.6 years, and malignant neoplasms constituted the primary cause of ascites (53.2%); 73% of patients had a Charlson Comorbidity Index indicating a high or very high risk of mortality within one year. All procedures were performed by family and community physicians. The median number of paracenteses was two procedures per Home Care Service admission (IQR: 1–6), and the median volume drained was 5 liters (IQR: 4.0–7.5). Half of the patients who required repeat paracenteses underwent a new procedure within eight days. Complications were reported in 4.7% of the procedures, and 3.4% involved major complications, such as bleeding, infections, clinical deterioration, and worsening of renal function. Three patients died due to events that, combined with the severity of their comorbidities, may be related to procedural complications. Conclusions: The study population consisted primarily of women over 50 years of age with liver cirrhosis or advanced-stage malignant neoplasms, who had a high burden of morbidity and mortality. The findings indicated that home paracentesis is a viable and safe practice and, according to the literature, offers benefits to the patient profile identified in the study. Based on the research findings, this study is expected to encourage and strengthen the practice of performing home paracentesis in other Home Care Service in Brazil