Large Volume Paracentesis
Large Volume Paracentesis
Patient with established history of ascites
Presenting with with need for therapuetic paracentesis
No concern for SBP, not requiring diagnostic paracentesis
By history or by exam, likely more than 4.5 L paracentesis required
BMP done in ED, Creatinine is near baseline
Altered Mental Status, concern for hepatic encephalopathy
Active Bleeding
Fever, or abdominal pain suggesting diagnosis of SBP
Decline in Renal Function
Perform paracentesis sufficient to relieve abdominal pressure and prevent ascites leak
If < 5 L of ascites removed, patient can be discharged without any additional management
If > 5 L of ascites removed, order and administer 6 grams of Albumin for every liter removed
Monitor for 6 hours after completion of procedure to monitor for hypotension
Disposition
Patient remains comfortable 6 hours post-procedure without development of hypotension
Establish outpatient followup for repeat BMP within one week
Hypotension, syncope, tachcyardia or other signs of abnormal fluid shifting