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143 Nurse led paracentesis for palliative care patients in the home setting in a low- and middle-income country: A case series
  1. Sunitha Daniel,
  2. Sheeba Jose,
  3. Vipin Paul,
  4. Sofi Johnson,
  5. Sarika Sanil,
  6. Athul Manuel,
  7. Geetha Vijayan and
  8. P Annie
  1. York and Scarborough Teaching Hospitals NHS Foundation Trust, UK, General Hospital, Ernakulam, India


Background Ascites in palliative care is associated with numerous distressing symptoms and can affect the quality of life of patients. Management of ascites-related symptoms is challenging especially in cancer patients due to the lack of evidence of response to diuretics. Abdominal paracentesis offers quick symptomatic relief but generally requires transfer to hospital for outpatient interventional radiology which is not easily available or financially feasible for patients in low- and middle-income countries.

Methods We present the results of the retrospective analysis of case notes of patients referred to our palliative care unit for nurse led paracentesis from November 2018 till date. These patients have an ultrasound confirmed ascites and first paracentesis in hospital setting. They are then referred for continuation of paracentesis at home.

Results Out of the eighty patients with median age of 65(38–96) seen by palliative care team at home, 59% were male, 47% had cancer (Hepatocellular 37%, Ovary 11%). Fifty-five (69%) of patients had less than 5 interventions while two (3%) had more than twenty interventions. The median number of days under the care of palliative care team was 29(3–712) were. Out of the twenty (25%) patients who are alive at the time of reporting, 75% are continuing with procedure while in 15% it was stopped as ascites resolved. There were no immediate post procedure complications though two (3%) had one episode of hospital admission with spontaneous bacterial peritonitis from which they recovered. Among the patients who had died, the median duration of referral to palliative care service before death was 33 (8–494) days.

Conclusion Nurse led home-based palliative paracentesis is a safe, effective, and convenient intervention for hospice and palliative care patients with symptomatic ascites.

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