Discussion Topic

Paracentesis

Posted on 03/26/09, 12:15 am
Yesterday, my husband had his third paracentesis. Upon each visit, the doctor drained what they say is their maximum safe amount of six vacuum bottles of fluid. The nurse said that each bottle equals about two and a half pounds. I would appreciate the input of the group regarding their experiences with this particular procedure. How do you normally schedule them? How often can they do them and how often is safe to undergo this procedure? Do you check your loved ones weight and girth before and after these procedures and if so, do you find it helpful? In what way? Believe me, I have more questions and I could go on, but I know that everybody in this group must be exhausted daily, so I will stop here. Any help you could offer will be much appreciated.
Showing 1 - 10 of 12 Replies
  • Reply #1 03/26/09  12:49am
    Hi,

    My BF has had 4 since October 2008. His last one was March 10 and I will be calling to schedule another one very soon. The last paracentesis, they took a little over 16 liters. The one before, a bit over 18. The other 2 were around 11 each. I usually call his GI doctor and let them know that he's ready for one. Of course, BF also has HRS-2 (hepatorenal syndrome) so he can't be drained unless his blood work is picture perfect. Huge PIA at times. I think the procedure should be done as often as needed to keep them comfortable (so long as it is safe to do so.) Any time they puncture the skin, there is a risk for infection. Another complication is the onset of HRS. Not a good thing. I do keep track of his weight daily but, I gave up on measurements a long time ago. Some days he is just too much of a bear to deal with, lol. The daily weigh-ins give me an idea of how much 'wet' weight he is picking up so they can adjust his diuretics as necessary. Plus it helps me to determine his 'dry' weight so I can see if he's is gaining any muscle mass back.

    I will tell you that my BF had a 'natural' paracentesis done last time around and he seemed to do so much better. He was up and around the very next day and has had much more energy than usual. I have no idea why though. I noticed that it takes quite a bit longer to do, than having it pumped out. I'm going to ask the GI doc what his thoughts are and will report them back to the group.

    Exhaustion is the norm here, but I know the others will be around soon to offer their wisdom as well. Ask as much as you'd like, we are all in this together.

    Take care and God bless.
  • Reply #2 03/26/09  12:12pm
    Whats the difference between a natural or oterwise paracentesis?
  • Reply #3 03/26/09  1:31pm
    Yes. I thought there was only one way to do it.
  • Reply #4 03/28/09  2:01pm
    Hello! Paracentesis,I can never get that word spelling memorized.lol Hubby has had probably around 30 of them done. We were told of one lady from the doctor who had around 100 of them done,can you imanage? I think the most hubby ever had drained was about 22 pounds or 11 liters. They tell us that one liter is a little over 2 pounds. Yes,if you have scales,weigh him before the drain and then after. The weighing will tell you how many pounds of fluid they drained. And will tell you if he is loosing or gaining any muscle mass. Say if he weighs 175 before the drain and after the drain he is 155,then they have drained 20 pounds of fluid. Keep track of his weight AFTER EACH drain to see if he is loosing muscle mass. Say if his weight is after first drain 155..then after the second drain he is 153,then he has lost 2 pounds of muscle mass. After the third drain,if he is 151,he is still loosing muscle mass. Just simply chart his weight before and after each drain and it will tell you fluid loss and muscle loss(or gain)of course after they tell you how much they drained. As far as to how often depends on how fast he is filling up and how fast you can get him scheduled for a drain. Our first doctor it was very hard to get into be drained quickly. We had to make appointments as soon as possible because he was being drained every 10 days. That became a poblem because it took 2-3 weeks to get another appointment. We had to go twice to the emegency room for emergency drains. we found another doctor and now he has no problem getting faster appointments. Thankfully the good Lord gave us the blessing of the fluid slowing down and he now only has to go every 2-3 months. The draining every 10 days went on for months. We need to contact btrflyeffect and get an answer on the "natural" paracentis,need to know what that is!!
  • Reply #5 03/28/09  7:14pm
    Hi Ladies,

    Sorry it's taken so long to respond. There just are not enough hours in the day. I know you all understand what I mean.

    I'm actually not entirely sure what a 'natural' paracentesis is. I was going to ask the GI doc about the difference on Wednesday, during BF's appointment. What I know is this... the previous 3 drainings BF had, they attached a pump to help pull the fluid off of him. Last time, they didn't. When BF asked the radiologist why not, he was told that they were doing a 'therapeutic' paracentesis this time around. They said it was a more 'natural' approach to draining the fluid. Now, being relatively new to this whole thing, I honestly don't have any idea what the differences are. I assumed it had something to do with the fact that he has HRS-2 on top of the ESLD, and maybe they were doing things more slowly so as not to put his kidneys in to shock??? Unfortunately, I am not allowed in the procedure area so I had no idea what was going on, except that it took quite a bit longer than usual. Normally, it's something like 90 minutes, this last time it took more than twice that amount of time. Plus, he was administered an IV with 'salt poor albumin' instead of what he usually gets (which is also albumin, but I think may be less the plasma aspect???) This also took much longer than usual. Normally we are in somewhere around 3.5 hours total. Last time, we were in most of the day. Plus, his BP dropped dangerously low right as they were set to discharge him, so he was sent for observation until his BP stabilized. This is the first time that has ever happened too. Even the way his orders were written up this last time was different. His regular GI doc was out of town and one of his associates sent in the orders instead. At any rate, BF did very well afterward. As some of you know, a paracentesis can take these guys down for a couple of days as their bodies try to re-adjust to the lack of fluid. Breathing is changed, organs must realign themselves, etc. BF was up and about the very next morning with energy that I have not seen in months. He said, he felt so much better this time. Heck, he even washed dishes. Believe me, I was shocked, lol.
    I often wonder about the safety in taking so much off at once and I do believe that the GI doc screwed up the first time out by not ordering albumin infusions. I wonder if the lack of albumin that first time didn't contribute to the HRS in some way. I have been doing some research when I can find the time.
    I wish they could set BF up with a better schedule for having the procedure done. They wait too long in between and they end up taking so much off that I worry for his health, safety, and longevity. He is unfortunate in the fact that he has no insurance, so he has to rely on our local free clinic (who are wonderful I have to say) and on the charity of the local hospital to keep up with labs, x-rays, and procedures. This is most likely why he has to wait so long in between procedures.
    Anyway, I will certainly let all of you know what the GI doc has to say as soon as I can.

    Until then, may God bless all of you and your loved ones.
  • Reply #6 03/28/09  10:02pm
    Ummm,interesting reply to the natural para. It's strange how some places allow the "other person" in when the para. is being done,and some don't. We've been to one place didn't allow me in with hubby,yet,in the emergency radiology dept they do allow it. Once a doctor allowed me to stay until he started to insert the needle,made me leave,then allowed me back in durning the actual drain. It has always taken about 4 1/2 to 5 hours for hubby's drain. They do a albumin drip in him every time. I was told if they drain 5 liters or less,the albumin wasn't neccessary. Some places will only do the albumin AFTER the drain,some will do it during the drain. It is much much faster if they do it durning the drain. Our hospital will only now give it to hubby after the drain and they move him to the after surgery recovery section to do it..it pumps up the bill that way(Yep,we got money to burn-NOT). Our liver specialist has partnerhip in his own out-patient surgery clinic and said he would so hubby's para. himself and give him the albumin during the drain,but our insurance does not cover the facility,so that's out. Hubby just said that he has had both ways,natural and the pump,both took hours to do. He said the natural one works like sifening(I have no idea how to spell that!) gas from a car. He is on a hospital table and the bottle is on the floor so that gravity allows the fluid to drain,that is what hubby says. As for how safe it is,some doctors try to wait as long as possible,before it becomes dangerous,to do them. But the fluid puts extreme strain on the organs and that is a danger too. So it is bad either way,as far as the extremes. Too much fluid is bad,too many para,s are bad. There is a risk of infections each time it is done and the proceedure is a delicate proceedure.They have to be sooo careful as to position the needle and such. Well,enough is enough talking. I'll hush for now. Byeee
  • Reply #7 03/28/09  11:27pm
    Ummm... not such an interesting reply, really. Just sharing my personal experience or hoping to, with further information from the GI doc. To be honest, I know of no medical establishment around here that allows the 'other person' in the procedure area. Something to do with integrity of the 'sterile environment.' Well, that and the fact that there are so many medical professionals milling about that 'other people' might get in the way. Again, just my experience.

    All of my BF's previous procedures have taken approximately 90 minutes. Of course this would be minus the pre and post-op care, so add another 1.5 or so hours to that, (barring any unforeseen complications.) However, the last one did take quite a bit longer. As I said, more than double the time compared to previous procedures. In 3 of the 4 procedures, albumin was given post procedure. Whether this is the norm, I can not say. I do know that upon further research, either is better than none at all. Generally speaking, with the loss of 9 or more liters. I'm sure this varies widely by facility, so again, just sharing MY experience.

    I asked my BF what his experience was this last time and he said it was all the same with the exception of the pump being not being used. I asked him if they placed the bottle on the floor and he said no, that they simply placed the collection bottle slightly lower on a table bedside and (as per usual) helped the process along by manipulating his body position, abdominal massage, and by actually gently pushing the fluid towards the drainage area. He told me that he even helps, lol. Bless his heart.

    The safety aspect is a totally different ball game. Leaving the fluid to build up is not good as this can leave the cirrhotic patient open to developing SBP (spontaneous bacterial peritonitis) which has a higher than average mortality rate. You also have the worry of pneumothorax or hydrothorax (both involving the lungs.) That said, the paracentesis also leaves the cirrhotic patient open to infection at the procedure site. Accidental damage to other organs, major arteries, nerves, etc. OR the development of HRS (hepatorenal syndrome) which can be acute or chronic. To minimize the risk of injury, most facilities will do an ultrasound guided paracentesis. Obviously, nothing is 100% foolproof, but better than the alternative, I suppose.

    I suggest that every 'other person' here ask questions of the doctors caring for your loved one and certainly research anything that you feel is important. Knowledge is power I always say, lol.

    Take care all and God bless.
  • Reply #8 03/29/09  6:25am
    I live in CT-won't mention the particular hospital providing the care, but they do not allow family in the room when setting up and starting the procedure. They did allow me in to sit with my husband during the drain. In his case, the vacuum bottles were placed between his knees and quickly switched out when full. I imagine it is something not everyone can watch, they do make a point to obscure the bottle until they get a clue as to how you will react to it. As far as amounts removed, the staff at this hospital have been consistent in stating that 6 bottles are the max that they are allowed to take out of him. It may just be a policy of theirs-I don't know. My spouse seems to endure quite a bit of pain at the point of entry during the procedure. The nurse said that was because the local that they had administered to numb the area had worn off by then. OUCH. Yes, they did do some abdominal massage to facilitate fluid removal. I would say (barring several delays related to paperwork and a fire drill), the whole process has been averaging about 2 hours per visit. I did ask about testing for infection and their policy on it. The staff told me that they test the fluid upon the patient's first visit, and upon all consecutive visits, only if there are outward symptoms of infection. Darned insurance companies. Thanks to all for the valuable advice and support. This website has been a godsend.
  • Reply #9 03/29/09  5:35pm
    Okay you guys have me totally freaked out now, Im not looking forward to this at all. Allthough sometimes I think Doc is waiting for him to burst.
  • Reply #10 03/31/09  1:46am
    Please don't freak out,sorry to overload you on all these things at once. After several times,it gets to be "old hat". It of course is never pleasant,but my hubby ALWAYS felt great relief after the proceedure is over with. There may be come discomfort when the organs kind of settle back into their normal positions,on the day of or the day after,but the pressure,and shortness of breath will be relieved. Now this IS a medical proceedure and of course cautions should always be a factor,for the medical personnel during the proceedure,and for you and your mister after the proceedure. He will not be able to drive for medical reasons,and they will tell you what to look for as far as any complications. So don't panic,it is something that simply has to be done if one suffers from acities. With the right diuretics and following orders,things may turn around for him like it has for my hubby. He went from having this proceedure every 10 days and them draining 11-12 litrs each time---to going only every 2-3 months having only 6-8 liters drawn. Heck,he feels like he's on vacation in between them now. Oh yea,if they only will drain 6 liters at a time,you may need to be vigilant on weighing him and use that to try to get him in to be drained. Is his doctor wanting to wait to be sure he has 6 liters to drain? These proceedures cost approx.$3,500 EACH,and that doesn't count the labs ect. Sooo,$10,500+ for just the paracentis' alone each month,it was running for hubby to have 3 of them every month,and that lasted for almost a year. OOps,didn't mean to ramble.

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