Tatiana Kelil MD, Presenter: Nothing to Disclose

Paul B. Shyn MD, Abstract Co-Author: Nothing to Disclose

Loraine Eng Wu MD, Abstract Co-Author: Nothing to Disclose

Ramin Khorasani MD, Abstract Co-Author: Consultant, Medicalis Corp

Stuart G. Silverman MD, Abstract Co-Author: Author, Wolters Kluwer nv

Because evacuated bottles are expensive and in short supply, we assessed the safety of using wall suction to drain and collect large amounts of fluid during image-guided paracentesis procedures.

This retrospective quality improvement project was HIPAA-compliant and did not require IRB approval. In a hospital-based practice, 551 image-guided paracenteses were performed in 191 consecutive patients (61 males and 130 females, ages 21-94, mean 61) over a 10-month period, using wall suction to collect the fluid. Each patient underwent 1 to 40 (mean 8.3) procedures. The two most common primary diagnoses were malignancy in 142 (74.3%) patients and cirrhosis in 36 (18.8%) patients. Paracenteses were performed using ultrasound (n =542) or CT (n = 9) guidance, 5-French centesis catheters, extension tubing (3 m long, 5 mm diameter), and 1-3 L plastic collection canisters attached to wall suction (up to -527 mm Hg). Volume of fluid removed and complications were recorded based on review of procedure dictation reports, the electronic medical record, and quality assurance logs with a minimum 30-day follow-up. Complications were graded using Common Terminology Criteria for Adverse Events, version 4.

The volume of fluid removed ranged from 35 to 11,965 ml (mean 3541 ml). Four (0.72%) complications occurred in 551 procedures; a rate similar to historical controls. Grade I complications included prolonged ascites leak (n = 1). Grade III complications included infection (n = 1), hypotension (n = 1) and atrial fibrillation (n = 1). All four complications were unrelated to the use of wall suction, and were treated successfully; no grade II, IV or V complications occurred. The small number of complications precluded adequate statistical power for comparisons to historical controls.

The use of wall suction when performing image-guided therapeutic paracentesis is a safe alternative to collecting fluid with evacuated bottles.

The current shortage of evacuated bottles has prompted the safe use of wall-suction to facilitate image-guided therapeutic paracentesis.

Kelil, T, Shyn, P, Wu, L, Khorasani, R, Silverman, S, Wall Suction-assisted Image-guided Therapeutic Paracentesis:  A Safe Alternative to Evacuated Bottles.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007495.html