Background:
A recent nationwide recall for large glass evacuated containers has led to new innovations performing large volume paracentesis (LVP). Compared to the individually manufactured evacuated containers traditionally used in the past, wall suction systems are relatively inexpensive and readily available on most inpatient floors. The ease of access and cost savings makes a wall suction approach an attractive alternative for LVP.
Purpose:
We wish to describe the efficacy, safety and cost-benefit of the standard wall suction system used in combination with a standard catheter over needle technique when performing LVP in hospital wards and emergency departments.
Description:
Large volume paracentesis using wall suction systems has been described in past emergency medicine literature, but never discussed as widely employed throughout an entire hospital population. At our tertiary care institution, the hospitalist-led invasive procedure team now universally performs ultrasound-guided LVP at bedside using a wall suction system. The standard wall suction regulators with plastic containers are connected via suction tubing to an 18 french paracentesis catheter. Once the intraperitoneal catheter is placed, suction tubing directly connects the catheter to the wall suction canister and suction of approximately 100 cm of water is applied. The use of wall suction separates the non-sterile suction containers from the sterile procedural field. The operator may break sterile scrub after the catheter is placed and change multiple non-sterile containers, without compromising any part of the sterile field or equipment. In the past 2 years since employing this new technique, we have not observed any intraperitoneal injury or other complications related to use of wall suction.
The utilization of wall suction canisters over the traditional glass or newer plastic evacuated containers also proves to be a cost effective technique. The price of plastic wall suction canisters is $0.75/liter as compared to $10.24/liter for the evacuated glass containers, which are now available only in limited supply. The newly, more readily available plastic evacuated containers cost $16.95/liter. At an estimated average LVP volume of 5 liters, we have seen a cost savings of $81 per LVP performed. Our procedure team performs on average 2-3 paracenteses per week, resulting in an annual cost savings of over $10,000.
Conclusions:
Standard wall suction is a safe, convenient, and cost effective method for performing LVP and is readily available at most inpatient institutions throughout the United States. While this may not currently be the standard of care nationwide, it has proven to be a more reliable and efficient alternative, making it the standard of practice for our hospitalist-led procedure team.