Short-term intraperitoneal catheters: An ambulatory care intervention for refractory ascites secondary to cirrhosis during COVID-19

Natalie L.Y. Ngu, Patricia Anderson, Jo Hunter, Anita Figredo, Timothy Papaluca, Stephen Pianko, Anouk Dev, Sally Bell, Suong Le

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background and Aim: Patients with refractory ascites have frequent hospital admissions, which pose exposure risks in the context of the COVID-19 pandemic. The aim of this study was to investigate the safety and efficacy of a novel 12-week, multidisciplinary ambulatory care program allowing frequent low-volume ascitic drainage through a tunneled, intraperitoneal catheter (IPC). Methods: Adult patients with cirrhosis complicated by refractory ascites were recruited through a liver clinic in a tertiary health service in Melbourne, Australia from April to December 2020. All patients were enrolled in a 12-week multidisciplinary program including medical, nursing, dietetics, and pharmacy support. A Rocket Medical IPC was inserted on day 1 with 1–2 L of ascitic fluid drained over 1–3 sessions per week either at the patients' homes or at the hospital day ward. Patients' demographics, death, complications, and self-reported outcomes were recorded. Results: Twelve patients were enrolled with a median of 65-day (interquartile range [IQR]: 16.5–93) IPC duration between April and December 2020 across two periods of COVID-related lockdown in Melbourne, Australia. There were no IPC-related deaths. Early removal was necessitated in three patients due to leakage, nonadherence, and bacteremia. On day 30, the median self-reported health score increased from 50 (IQR: 50–70) to 78 (IQR: 50–85), attributable to a reduction in symptom burden. Conclusion: A multidisciplinary IPC program including the use of short-term IPC was safe and associated with a self-reported improvement in perceptions of health. In the context of the COVID-19 pandemic, the program aimed to reduce patient and clinician exposure, which is maintaining engagement and management of decompensated cirrhosis.

Original languageEnglish
Pages (from-to)1154-1159
Number of pages6
JournalJGH Open
Volume5
Issue number10
DOIs
Publication statusPublished - Oct 2021

Keywords

  • ascites
  • cirrhosis
  • COVID-19

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