Background: New internal medicine interns are expected to be familiar with bedside procedures such as paracentesis. Medical students frequently have inadequate dedicated time to learn bedside procedures and are taught in a fragmented manner. As a result, new interns lack familiarity with these procedures. As such, we assessed whether a comprehensive module for paracentesis would [...]

Background: The American Board of Internal Medicine suggests residents participate in a minimum of five abdominal paracentesis (AP), central venous catheter (CVC) placements, and lumbar punctures to ensure “adequate knowledge and understanding” of procedures performed by practicing internists. Competency in these procedures is poorly defined and difficult to assess. To address the need for well-supervised, [...]

Background: Paracentesis is a common procedure for patients with decompensated cirrhosis. In patients with cirrhosis and superimposed renal impairment, clinicians may hesitate to perform a large volume paracentesis, given concerns of intraabdominal fluid shifts resulting in further renal dysfunction. In this study, we aimed to answer whether greater ascites fluid removal was associated with 48-hour [...]

Background: Ultrasound-guidance has become the standard for bedside procedures in the emergency and inpatient settings due to its perceived impact on first attempt success and complications. Prior literature on paracentesis notes a 10% rate of overall complications, 5% rate of technical problems, and a 1% rate of bleeding. However, existing cohorts often include outpatients or [...]

Background: Patients with cirrhosis complicated by ascites are often admitted to the hospital and require abdominal paracentesis for diagnostic evaluation and symptom relief. When large volumes are removed there is a risk for acute kidney injury (AKI) which can contribute to morbidity and mortality. There are no clear guidelines for what constitutes a safe volume [...]

Background: Ultrasound-guided thoracentesis and paracentesis are frequently performed for both diagnostic and therapeutic indications. While the risk of aspiration is low, our institution has historically required patients to be fasting for 4 hours prior to the procedure. In the hospital setting, unnecessary fasting requirements could contribute to missed patient meals and procedure delays. Here, we [...]

Background: Large volume paracentesis is commonly performed in patients with refractory ascites but can induce hypotension and kidney injury. There is evidence that administering albumin at 6-8 grams per liter (g/L) of ascites removed during or after paracentesis can reduce these adverse events. Current guidelines recommend this practice when >2 liters are removed in high-risk [...]

Background: Spontaneous Bacterial Peritonitis (SBP) is associated with high mortality.  A recent article[1] showed that, in the setting of SBP, delayed paracentesis was associated with increased mortality.  Because of the clinical ramifications of this association, we attempted to recreate this finding using our local patient population. Methods: Similar to the study that prompted this inquiry, [...]

Background: Paracentesis is associated with decreased mortality in patients with advanced liver disease. The prevalence of paracentesis related complications is not well characterized, but prior studies suggest improved safety outcomes when ultrasound guidance is employed.  The Agency for Healthcare Research and Quality utilizes patient safety indicator (PSI) 27 to identify postoperative bleeding complications. Our aim [...]

Background: Therapeutic paracentesis is a common procedure performed to relieve symptoms of ascites most commonly from cirrhosis, heart failure or malignancy. Previous studies have shown that acute kidney injury (AKI) is common after paracentesis and portends a poor prognosis, although these studies have excluded patients with pre-existing chronic kidney disease (CKD). Experiences in our hospital [...]