Core IM Podcast: Mind the Gap Part 2 on Paracentesis

November 29, 2017


Should a cirrhotic’s INR and platelets deter you from doing a paracentesis? Do you need to transfuse prior to a paracentesis? Do generalist have worse procedure complications than specialists?  Go deeper with Dr. Steve Liu and Dr. Janine Knudsen! Illustration by Dr. Mike Natter.

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Time Stamps

Do you need to check pre-procedural INR or platelets? (3:15)

Do we need specialists for performing paracentesis? (5:40)

Do you need to send ascites fluid in blood culture bottles? (6:10)

Take away points

  1. It has been shown in cirrhotic with INRs greater than 1.5 and platelets less than 50, there were minimal complication rates after paracentesis.
  2. Platelet transfusion prior to paracentesis is grade III recommendation. It was neither useful nor effective, and it can even be harmful.
  3. General internists had the similar safety outcomes as IR specialists and gave fewer platelets and FFP transfusions.
  4. Sending paracentesis fluid in blood culture bottles increased yield.

Many thanks to Dr. Renee Williams, Gastroenterologist at NYU, for peer reviewing this episode.

References

3:15 Should a cirrhotic’s INR and platelets deter you from doing a paracentesis?

Wong CL, Holdoryd-Leduc J, Thorpe KE, Straus SE “Does this patient have bacterial peritonitis or portal hypertension? How do I perform a paracentesis and analyze the results.” JAMA. 2008;299(10):1166-1178    

Grabau CM, Crago SF, Hoff LK, Simon JA, Melton CA, Ott BJ, Kamath PS “Performance standards for therapeutic abdominal paracentesis” Hepatology 2004; 40:484-488

Lin CH, Shih FY, Ma MHM, Chiang WC, Yang CW, Ko PCI. “Should bleeding tendency deter abdominal paracentesis?” Digestive and liver disease 37 (2005) 946-951

5:40 Do generalist have worse procedure complications than specialists?

Barsuk JH et al. “Specialties performing paracentesis procedures at university hospitals: Implications for training and certification.” J. Hosp. Med. 2014 March;9(3):162-168

Barsuk JH et al. “Clinical outcomes after bedside and interventional radiology paracentesis procedures”. Am J Med. 2013 Apr;126(4):349-56

Barsuk JH et al. “Cost savings of performing paracentesis procedures at the bedside after simulation-based education. Simul Healthc. 2014 Oct;9(5):312-8.

6:10 Do you need to send ascites fluid in blood culture bottles?

Runyon, Bruce A., Edith T. Umland, and Toby Merlin. “Inoculation of blood culture bottles with ascitic fluid: improved detection of spontaneous bacterial peritonitis.” Archives of internal medicine 147.1 (1987): 73-75.