Safety of paracentesis in inpatients

• Published in: Clinical nephrology Vol. 66; no. 3; p. 171
• Main Authors: Duggal, P, Farah, K F, Anghel, G, Marcus, R J, Lupetin, A R, Babich, M M, Sandroni, S E, McGill, R L
• Format: Journal Article
• Language: English
• Published: Germany 01.09.2006
• Subjects: Acute Kidney Injury - pathology; Adolescent; Adult; Aged; Aged, 80 and over; Albumins - administration & dosage; Albumins - pharmacology; Creatinine - blood; Demography; Equipment Safety; Female; Humans; Inpatients; Male; Middle Aged; Paracentesis - adverse effects; Paracentesis - instrumentation; Paracentesis - standards
• ISSN: 0301-0430
• DOI: 10.5414/cnp66171

Prior research has suggested that paracentesis is free from complications such as acute renal failure (ARF) providing albumin is administered. Actual safety of paracentesis > 1,000 ml was assessed at a tertiary care hospital. 300 inpatient paracenteses performed between 12/99 and 4/04 were identified by coding records, of which 40 procedures were excluded due to lack of pre- or post-procedure lab values. Charts were reviewed for serum creatinine (Scr) before and after procedures, ascites volume, and clinical outcomes. 44 deaths occurred after 260 paracenteses (16.9%). Among 33 patients with ARF, 13 (39.4%) died. Only 31/227 patients without ARF (13.7%) died (p < 0.001). Serum creatinine (Scr) > 1.6 mg/dl prior to paracentesis predicted a 22.5% rate of ARF, compared to 8% for Scr < 1.0 (p = 0.002). ARF increased as volume increased (9.9%, 12.4%, and 14.9%, for volumes of < 2,300, 2,300 - 3,200, and > 3,200 ml) but this trend did not have statistical significance (p = 0.426). ARF occurred in 11/69 (15.9%) of patients receiving albumin, compared to 22/191 (11.5%) of patients who did not (p = 0.462). Paracentesis in inpatients has significant rates of ARF and death. Scr > 1.6 prior to paracentesis predicts an increased rate of ARF. Development of ARF is associated with an increased rate of death. No advantage was demonstrated with administration of albumin. Pre- and post-paracentesis labwork should be routine in inpatients.