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P-41 Expansion and development of a hospice paracentesis service to include non-malignant ascites
  1. James Coxon
  1. Hospice in the Weald, Pembury, UK

Abstract

Introduction Along with most UK hospices, Hospice in the Weald have an established paracentesis service for managing malignant ascites. These represent 10% of ascites cases in the UK with the majority of the rest attributable to cirrhosis. Cirrhosis is the fifth commonest cause of death in the UK, but is less familiar to hospice services than malignancy. We present a successful QIP expanding the service to patients with non-malignant ascites

Aims A Quality Improvement Project to introduce intravenous albumin during paracentesis facilitating drainage of non-malignant ascites in a hospice setting.

Methods Through consultation with hospice and local trust pharmacys we were able to source 20% Human Albumin Solution initially on private prescription and then direct from the manufacturer. Guidelines were developed combining the International Ascites Club guidelines, local trust protocols and medical staff experience which were reviewed at the weekly hospice journal club.

Results Over 10 months we have successfully used albumin during paracentesis on 6 occasions. There have been no complications during the procedures and have been more haemodynamically stable than those with malignant ascites and similar drainage volumes.

Conclusion Through the introduction of albumin cover we have been able to expand our patient group, avoid hospital admissions, as well to provide opportunities for advanced care planning. It has been particularly helpful for patients with ascites with malignancy and a background of liver disease as previously there was a risk draining in the hospice without albumin. It is expected that as local referrers become more aware that the service will become more popular.

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