title: The safety and feasibility of large volume paracentesis performed by an experienced nurse practitioner.
abstract: Due to time constraints, fewer physicians are performing large volume paracentesis (LVP) resulting in a longer wait time and more emergency department (ED) and hospital admissions. At our institution, after initial supervision, a certified nurse practitioner (NP) has independently performed LVP in a dedicated cirrhosis clinic. The purpose of our study was to evaluate the feasibility and safety of LVP performed by a NP. A retrospective review of patients undergoing LVP between January 2003 and May 2007 was performed. Baseline patient information and the practitioner performing LVP (physician or NP) were recorded. Complications including post paracentesis hypotension, bleeding, local leakage of ascitic fluid, infection, perforation, and death were compared between the two groups. A total of 245 procedures in 41 patients were performed by a single NP, and 244 in 43 patients by physicians. Baseline characteristics of patients undergoing LVP were similar in two groups. Alcohol was the most common etiology of cirrhosis (46% in NP and 51% in physician group) followed by a combination of alcohol plus HCV (37% in NP and 28% in physician group). There was similar distribution of Childs class B and C patients in the two groups, as well as average MELD score. Total volume of ascites removed, number of needle attempts, and complications including post paracentesis hypotension, local leakage of ascitic fluid, bleeding, infection, and death were not statistically different between the two groups. Our study shows no difference between physician and NP performance of LVP and complication rates. LVP performed by a NP is feasible and has acceptable rate of complications.
authors.affiliation: Department of Gastroenterology and Hepatology, Carl. T. Hayden VA Medical Center, Phoenix, Arizona 85012, USA. ngilani@pol.net
authors.forename: Nooman
authors.initials: N
authors.lastname: Gilani
authors.forename: Nayan
authors.initials: N
authors.lastname: Patel
authors.forename: Richard D
authors.initials: RD
authors.lastname: Gerkin
authors.forename: Francisco C
authors.initials: FC
authors.lastname: Ramirez
authors.forename: Erin E
authors.initials: EE
authors.lastname: Tharalson
authors.forename: Kandarp
authors.initials: K
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001202:Ascitic Fluid / Q000378:metabolism; D002983:Clinical Competence; D005240:Feasibility Studies; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007022:Hypotension / Q000209:etiology; D008103:Liver Cirrhosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D019152:Paracentesis / Q000009:adverse effects* / Q000592:standards*; D010538:Peritonitis / Q000209:etiology; D010820:Physicians; D012189:Retrospective Studies; D016896:Treatment Outcome