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Your referral to the Hepatology Department
You have been referred to the department for removal of possible ascites, which may require a procedure known as Large Volume Paracentesis (LVP).
What is ascites?
Ascites is the medical term for a build-up of fluid in the abdomen (tummy). It is normal for a small amount of fluid to be in the abdominal cavity, and this is continuously being created and absorbed. There are several causes of ascites however it most commonly occurs in patients with liver disease.
What are the symptoms of ascites?
The presence of the excess fluid in the abdomen can cause several symptoms, including swollen tummy resulting in pain, poor appetite, shortness of breath, indigestion, nausea and vomiting and reduced mobility (difficulty in walking).
What can be done about it?
To reduce the symptoms, we need to remove the excess fluid. This can be done by taking medication known as diuretics or water tablets (commonly spironolactone), however sometimes the quickest way of removing the fluid is to drain it using a temporary tube, known as a drain, inserted into the abdomen. This procedure is known as paracentesis.
What are the benefits of the procedure?
What are the risks of the procedure?
As with any procedure, there are risks and complications. Paracentesis is a safe procedure with a small rate of significant complications.
What happens during the procedure?
At the start of your procedure, you will be required to lie on a bed. A tube will be inserted to act as a drain. The Doctor or Hepatology Nurse will examine you to decide the best position to insert the drain into your abdomen. The Doctor or Hepatology Nurse will use an ultrasound scan in order to locate the fluid.
Once the best place for the drain has been decided, we will thoroughly clean the site before giving a small injection of a local anaesthetic to numb the area before inserting the drain.
The drain will be securely attached to your skin with an adhesive dressing; it will then be attached to a bag to collect the fluid coming from your abdomen. The drain will stay in place for a maximum of six hours or until 10 litres of fluid has been drained, this is to minimise the risk of infection. The drain will then be removed.
A blood product called Human Albumin (HAS) will then be given for every 2-3 litres of fluid drained. You will also be monitored regularly, a process known as carrying out observations.
Arranging a Drain
The initial procedure will be done as an inpatient at the bedside under strict sterile technique. In some instances, the procedure might require an ultrasound guided insertion of the drain in the X-ray department.
If further drainage is needed, this can be done as a day case in the Planned Care Unit (PCU) or in Ward 8.
Drains in Ward 8 – If you need to come in (TCI) to Ward 8 then this will be arranged, and a confirmatory letter with instructions will be sent to you.
LVP as a day case in PCU- the procedure will be arranged by the Hepatology Specialist Nurse or Doctor. A letter will be sent for you to come in for a day case and for a blood test to be arranged prior to the procedure in Milton Keynes University Hospital.
The day of your appointment in PCU
The appointment will be for you to attend at 8.00 am to ensure there is plenty of time during the day to carry out the procedure. The procedure is normally completed on the day of your appointment.
It is advisable to wear something loose around your abdomen, for example jogging bottoms or a loose-fitting skirt, or you can bring a change of clothing with you. It is advisable that a responsible adult brings you to your appointment and is available to take you home afterwards. Transport can also be arranged if necessary.
On the day of your appointment do not take your diuretics, for example spironolactone or furosemide. Please ensure you bring a list of all your current medication with you.
What happens after the procedure?
Once the Nurse is satisfied that you have no bleeding from the drain site and your temperature and blood pressure are stable you will be discharged home. This is usually about 8 hours from your arrival at the PCU.
Do you have to stay in hospital overnight?
For most patients, the procedure is carried out as a day case. Once the drain is removed and you are feeling well you should be able to return home. However rarely you may need to be admitted to the ward.
What to do once you get home?
You should weigh yourself daily and measure around your abdomen weekly, keeping a record of this will help plan for any future appointments you may need.
For further advice or information contact: