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

Autor: Ngu NL; Department of Gastroenterology and Hepatology Monash Health Melbourne Victoria Australia.; Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Victoria Australia., Anderson P; Department of Gastroenterology and Hepatology Monash Health Melbourne Victoria Australia.; Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Victoria Australia., Hunter J; Department of Gastroenterology and Hepatology Monash Health Melbourne Victoria Australia.; Pharmacy Department Monash Health Melbourne Victoria Australia., Figredo A; Hospital in the Home Monash Health Melbourne Victoria Australia., Papaluca T; Department of Gastroenterology and Hepatology Monash Health Melbourne Victoria Australia., Pianko S; Department of Gastroenterology and Hepatology Monash Health Melbourne Victoria Australia.; Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Victoria Australia., Dev A; Department of Gastroenterology and Hepatology Monash Health Melbourne Victoria Australia.; Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Victoria Australia., Bell S; Department of Gastroenterology and Hepatology Monash Health Melbourne Victoria Australia.; Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Victoria Australia., Le S; Department of Gastroenterology and Hepatology Monash Health Melbourne Victoria Australia.; Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Victoria Australia.
Jazyk: angličtina
Zdroj: JGH open : an open access journal of gastroenterology and hepatology [JGH Open] 2021 Sep 01; Vol. 5 (10), pp. 1154-1159. Date of Electronic Publication: 2021 Sep 01 (Print Publication: 2021).
DOI: 10.1002/jgh3.12641
Abstrakt: 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.
(© 2021 The Authors. JGH Open: An open access journal of gastroenterology and hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)
Databáze: MEDLINE
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