title: A Randomized Controlled Trial of Procedural Techniques for Large Volume Paracentesis.
abstract: The aim of this study is to investigate large volume therapeutic paracentesis using either a z-tract or axial (coxial) technique in a randomized controlled trial.
  
  
  
  In this randomized, single blind study, patients with cirrhosis undergoing outpatient therapeutic paracentesis were randomized to the z-tract or the modified angular (coaxial) needle insertion technique. Subject and procedure characteristics were compared between the groups with ascites leakage as quantified by need for dressing changes with standardized sized gauze pads as a primary endpoint and subject procedural discomfort, operator preference, and procedure complications as secondary endpoints.
  
  
  
  72 paracenteses were performed during the study period: 34 to the z-tract and 38 to the coaxial insertion technique. Following exclusions, a total of 61 paracenteses were analyzed: 30 using the z-tract technique and 31 using the coaxial technique. There were equal rates of post-procedural leakage of ascites between groups (13% in both groups, p = 1.00). Using the visual analog scale (0 - 100), there was a statistically significant increase in the subject reported pain score with the z-tract compared with the coaxial method [26.4 (95% CI 18.7 - 34.1) vs. 17.2 (95% CI 10.6 - 23.8), p = 0.04]. Mean physician rated procedure difficulty (1 - 5) was significantly higher for the z-tract versus the coaxial technique [2.1 (95% CI 1.6 - 2.6) vs. 1.5 (95% CI 1.2 - 1.8), p = 0.04].
  
  
  
  When compared to the z-tract technique, the coaxial insertion technique is superior during large volume paracentesis in cirrhosis patients.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Shriver
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Rudnick
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Intagliata
authors.affiliation: University of Virginia School of Medicine, Charlottesville, Virginia, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Wang
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Caldwell
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Northup
mesh_terms: D000553:Ambulatory Care; D001201:Ascites / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000009:adverse effects / Q000379:methods*; D016037:Single-Blind Method; D016896:Treatment Outcome; D014768:Virginia
keywords: Ascites; Peritonitis; cirrhosis; complications; invasive; procedures