Management of Malignant Ascites
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What is ascites?
Ascites is a condition when too much fluid is produced inside the abdomen. Inside the abdomen there is a membrane called the peritoneum. The peritoneum produces a fluid that acts as a lubricant and allows the abdominal organs to glide smoothly over one another. Sometimes too much of this fluid can build up – this is called ascites and it can occur with illnesses such as liver disease & some cancers.
Why should it be drained?
The symptoms of ascites can be distressing. The abdomen becomes swollen and stretched, which can be uncomfortable or painful. It can also cause difficulty in getting comfortable, sitting up or
walking. It can make you feel very tired, lethargic and breathless. It may cause feelings of sickness (nausea) or make you sick (vomiting). Severe ascites may also affect the circulation, especially blood return from the legs. You may also suffer indigestion and a reduced appetite and constipation. Removal of the fluid can improve some or all of the symptoms mentioned above. Drainage is a simple technique and it can be used for diagnostic or treatment purposes.
How is it treated?
The treatment of ascites can involve putting a tube into the abdomen to drain the excess fluid. Before the procedure, the doctor will explain what will happen and ask you to sign a consent form.
The tube (drain) is inserted by an experienced doctor either in an area within the X Ray department( interventional suite) or sometimes the procedure can be done at the bedside in the ward following an ultrasound scan for marking the area. Sometimes the drain may be inserted in the ultrasound department whilst scanning the abdomen. This helps the doctor find exactly where to put the drain, especially if the fluid appears to be in small pockets and cannot be drained all at once.
The doctor gives an injection of local anaesthetic into the area to prevent the procedure from being painful. The tube (drain) is inserted into the abdomen and when the intruder is removed leaves a length of soft flexible tubing via which the ascitic fluid can be drained. The Drain may be held in place with a couple of stitches but more often with just a dressing. The length of time that the drainage tube needs to stay in place depends on the amount of fluid that needs to be drained off. Most often, the drain will be in place for 6 – 8 hours or until a certain volume has been drained, occasionally this may be several days.
During this time, you should rest in bed. A sample of fluid may be sent for analysis in the laboratory. It is possible for the ascites to build up again and drainage may need to be carried out more than once. For those patients that experience recurrent ascites it may be possible to insert a long term drain. It may then be possible for your Community nurse to drain this for you at home but this will be discussed by your Doctor or Nurse.
Possible short-term problems
Your blood pressure will be checked during and after the procedure and if you feel unwell, the drain may be clamped. This may be because the fluid has drained too quickly and your blood pressure has dropped, but this should not be a problem with careful monitoring. The tube (drain) can become blocked. This can sometimes be cleared by changing your position or sitting upright. Occasionally the tube may need to be replaced.
The drain can become infected and you will have your temperature taken regularly, as a high temperature can be a sign of infection. The chance of this is very low as the drain is in place for only a short time under sterile procedures. When the drain has been removed, there may be a leakage of fluid from the drain site until the hole heals. The hole may be stitched together and the site will need to be covered with a dressing or drainage bag until the leakage has stopped. Usually the stitches are taken out after about a week.
It is important to alert your doctor
If you are taking blood thinning medication such as Aspirin, Clopidogrel, Apixaban, Warfarin, Fragmin, Dalteparin or Clexane because they can increase the risk of bleeding. Your doctor will advise you on whether to stop taking these before the drain insertion and when to re-start.
Are there any alternative treatments?
Sometimes the build-up of ascites in liver patients, can be slowed by using diuretic drugs (water tablets). Your doctor will be able to advise you whether other treatments could be suitable for your particular illness.
Long term drainage catheters (Sometimes called Rocket drains)
Occasionally patients with recurrent ascites require regular drainage whilst at home. This can be managed at home by the district nurses from your GP surgery, however this requires a different type of drain & if this is considered appropriate for you, your Doctor will discuss this with you. Ask for the Rocket Medical Patient information booklet.
How soon will I recover?
You may be able to go home on the same day as the procedure but it is advisable you that are driven home and accompanied for the next 12 hours at least. There may be some pain at the site of the tube (drain) insertion and occasionally pain can occur in the back or shoulders, but these should respond to simple pain killers, ask your Doctor to advise you which painkillers would be most suitable for you. If you develop severe pain in your abdomen, shoulder or chest or develop a fever, chills or shortness of breath, inform the nurse in charge or if you have been discharged contact your GP surgery as soon as possible.