title: Central venous pressure catheter for large-volume paracentesis in refractory ascites.
abstract: OBJECTIVE
  About 10 % of cirrhotic patients are unresponsive to sodium restriction and diuretics and develop refractory ascites. Such patients usually require recurrent large-volume paracentesis and lots of hospital admissions. Hereby, we introduce a method applying a central vein (CV) catheter for large-volume paracentesis in patients with refractory ascites in up to 4 days associated with sodium restriction and high dose of diuretics.
  
  
  METHODS
  Non-tunneled triple lumen CV catheter was used to drain the ascites fluid of 30 cirrhotic patients. After precise percussion, the point of highest fluid accumulation was marked for puncture. Then, the skin and subcutaneous tissue were anesthetized. CV catheter set guide wire was entered into the peritoneal cavity and the dilator of the CV catheter set was passed through the guide wire and extracted after some rotations around its insertion site on the skin. The catheter was passed over the guide wire and the guide wire was extracted gradually from one of the lumens and fixed to the skin.
  
  
  RESULTS
  Nineteen males and 11 females with mean (±SD) age of 59.4 ± 11.7 years old underwent the procedure. A minimum of 9 and maximum of 29 L (12 ± 6.6 L) ascites fluid drained during a minimum of 2 and maximum of 5 days of hospital stay. All catheters were patent during the drainage. None of the patients developed hemodynamic instability. Number of re-hospitalizations for paracentesis was 1.9 times during the following year. No complication occurred.
  
  
  CONCLUSIONS
  This technique is a simple noninvasive method that can be performed in the endoscopy unit or even at the patient's bedside and may reduce the need for repeated admissions.
authors.affiliation: Colorectal Research Center, Rasool-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran, ddri.tums@gmail.com.
authors.forename: Shahram
authors.initials: S
authors.lastname: Agah
authors.forename: Sahar
authors.initials: S
authors.lastname: Tavakoli
authors.forename: Hajar
authors.initials: H
authors.lastname: Nikbakht
authors.forename: Mehrdokht
authors.initials: M
authors.lastname: Najafi
authors.forename: Abdolreza
authors.initials: A
authors.lastname: Al-Agha
mesh_terms: D000368:Aged; D001201:Ascites / Q000209:etiology* / Q000628:therapy*; D062905:Central Venous Catheters; D004039:Diet, Sodium-Restricted / Q000009:adverse effects; D004232:Diuretics / Q000009:adverse effects; D004322:Drainage / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D004232:Diuretics
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