Case study: Great Western Hospital’s nurse-led day case paracentesis service

Published: 16 November 2012

The Radiology Department at the Great Western Hospital has developed and been running a successful nurse led day case paracentesis service for management of malignant ascites.

The service, led by Sister Alice Bevan, has received excellent feedback from both patients and the professionals who access the service for their patients.

Recurrent malignant ascites is associated with distressing and lifestyle limiting symptoms. Ultrasound-guided paracentesis is a safe and effective way of managing symptoms in these palliative patients, which has traditionally been performed by doctors in an inpatient setting. The team set out with the aim of developing a dedicated nurse-led service in radiology to offer symptomatic relief via a planned paracentesis service to appropriate patients, the aim being to improve access to care, prevent hospital admission and therefore quality of life for these palliative patients.

A comprehensive literature review was conducted and a trust clinical competency and lidocaine PGD established. A proposal for the new service was written in conjunction with a palliative care consultant from the local hospice including inclusion and exclusion criteria. Alice undertook a tailored ultrasound module through the UWE and was taught to technically perform the paracentesis by Consultant Radiologist Dr Andy Beale.

To access the service, the initial referral is made via oncology, palliative care or the patient’s GP, direct to the radiology nurses. After the initial referral the patients are encouraged to self refer for repeat procedures as necessary.

The radiology nurses maintain close contact with the referring teams and consequently some very effective working relationships with these teams have been built through running this service. Ascites is tapped with a 14G IV cannula (or equivalent if cannula is not long enough) and aspirated. Unless the patients are hospice inpatients they have a blood pressure recorded before the drainage and it is then monitored afterwards. If the blood pressure is stable and the patient is not experiencing any symptoms of hypertension then they are discharged 30 minutes after the cannula is removed.

Through analysis of the blood pressure readings taken on these patients it has been shown that there is no significant change in blood pressure caused by drainage of malignant ascites.

To date, over the last two years, 167 ultrasound guided paracentesis’ have been performed on 47 patients. All patients were safely discharged after between 1.5 and three hours in the department. There were no known complications as a result of paracentesis over this period. An average of 4.8 litres was taken per attendance (range, 1.4 – 9.0). All patients were seen within two working days of request unless otherwise indicated by the patient.

Opinions on the service have been sought from both patients and the referring staff; results of both surveys have been overwhelmingly positive. Some of the words patients used to describe the service are ‘invaluable’, ‘competent’, ‘professional’, ‘friendly’, ‘quick’ and ‘wonderful’. More than one patient also mentions that the procedure is significantly less painful than the traditional procedure where ascites is drained with a bonanno catheter. One patient’s family were so appreciative of the service that they organised an event which raised more than £600 for our charitable funds.

Alice and the team are really proud of the service which has both improved quality of life for patients but also raised the profile of radiology nurses in the hospital.