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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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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
- It has been shown in cirrhotic with INRs greater than 1.5 and platelets less than 50, there were minimal complication rates after paracentesis.
- Platelet transfusion prior to paracentesis is grade III recommendation. It was neither useful nor effective, and it can even be harmful.
- General internists had the similar safety outcomes as IR specialists and gave fewer platelets and FFP transfusions.
- Sending paracentesis fluid in blood culture bottles increased yield.
Many thanks to Dr. Renee Williams, Gastroenterologist at NYU, for peer reviewing this episode.
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.