title: Large-volume paracentesis in the management of ascites in children.
abstract: BACKGROUND
  Large-volume paracentesis has been evaluated for both therapeutic and diagnostic purposes in the management of ascites in cirrhotic adults. There are no published data relating to the safety, efficacy, or methods of this procedure in children. The objective of this study was to characterize the authors' initial experience with large-volume paracentesis (> 50 ml/kg of ascites) for removal of tense abdominal ascites in the pediatric population.
  
  
  METHODS
  Retrospective chart review was performed of 21 large-volume paracentesis sessions in seven children (ages 6 months-18 years) with tense ascites that did not respond to other measures.
  
  
  RESULTS
  Mean volume removed was 3,129 +/- 2,966 ml (mean +/- standard deviation) or 118 +/- 56 ml/kg over 2.9 +/- 3.7 hours by a 16-gauge intravascular catheter in 6 sessions, by an 18-gauge intravascular catheter in three sessions, and by a 15-gauge fenestrated, stainless-steel paracentesis needle in 12 sessions. Large-volume paracenteses performed with the paracentesis needle had significantly shorter duration of drainage and faster flow rates than those performed with the intravascular catheter. The only complication encountered was decreased urine output in one session.
  
  
  CONCLUSIONS
  Large-volume paracentesis is a safe and effective therapeutic method for managing tense abdominal ascites in children. The use of the paracentesis needle significantly improved the speed and efficiency of large-volume paracentesis compared with the intravascular catheter.
authors.affiliation: Pediatric Liver Center and Liver Transplantation Program, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Children's Hospital and University of Colorado Health Sciences Center, Denver, Colorado 80218, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Kramer
authors.forename: R J
authors.initials: RJ
authors.lastname: Sokol
authors.forename: B
authors.initials: B
authors.lastname: Yerushalmi
authors.forename: E
authors.initials: E
authors.lastname: Liu
authors.forename: T
authors.initials: T
authors.lastname: MacKenzie
authors.forename: E J
authors.initials: EJ
authors.lastname: Hoffenberg
authors.forename: M R
authors.initials: MR
authors.lastname: Narkewicz
mesh_terms: D000293:Adolescent; D001201:Ascites / Q000628:therapy*; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D004322:Drainage; D005260:Female; D006801:Humans; D007223:Infant; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology; D008297:Male; D009339:Needles; D019152:Paracentesis / Q000009:adverse effects / Q000379:methods*; D010953:Plasma Volume / Q000502:physiology; D011677:Punctures; D012189:Retrospective Studies; D012449:Safety; D016896:Treatment Outcome