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Outpatient Large-Volume Paracentesis

Paracentesis Collaboration Flowchart.pdf

Ordering US Paracentesis.pdf

Purpose: This process is designed to reduce admissions for patients who just need a large volume paracentesis (LVP) to relieve ascites.

Scope: It applies to patients in the UED, HED, and GED with ascites who you think would be stable and appropriate for discharge after an LVP with expedited follow up.

Process:

1. Weekday Daytime (Monday – Friday, 6:30a-4p)
   • Step 1: Vocera the group: ”**ED Paracentesis Referral” ****with the patient’s information
   • Step 2: Place an order for “US Paracentesis” - this must be ordered under an “outpatient encounter”. Please see the attached documented “Ordering US Paracentesis” for a quick guide on how to do this. It’s a fairly simple process once you know the steps.
   • Step 3: Once you confirm the timing of the procedure with the team, discharge the patient with the instructions “ED Paracentesis Post Discharge Instructions.” They will go the 6th floor North Pavilion Radiology waiting room at their appointment time for their procedure. Patients at GED and HED would need to drive to their appointment.
2. Weekday Overnight (Sunday – Thursday, 4:30p-6:30a)
   • Step 1: Call ultrasound sonographer at 4-1383 and they will place the patient on the schedule for 6:30am in the morning. Do not page the ED Paracentesis Referral group, they won’t be monitoring it during overnight hours and they don't want overnight pages.
     • NOTE: If you cannot reach the ultrasound sonographer, continue with the plan of discharging patient (or holding them in the ED) till their procedure at 6:30; but send a communication message in impact to Molly Miller and Emily Forrester
   • Step 2: Order “US Paracentesis”
   • Step 3: Once you confirm the timing of the procedure with the team, discharge the patient with the instructions “ED Paracentesis Post Discharge Instructions.” They will go the 6th floor North Pavilion Radiology waiting room at 6:30am for their procedure. Patients at GED and HED would need to drive to their appointment.
3. Weekends (Friday 4:30p – Sunday 4:30p)
   • Option 1: If during the day, order "Procedure Service Consult" and also contact the team “Procedure Service” on Vocera to check if the hospitalist procedure team can prioritize and perform the paracentesis in the ED (note GED and HED patients would need to be transferred ED to ED for this service).
   • Option 2: Provide ”US Paracentesis” follow up (by calling the sonographer at 4-1384) and they will have them follow up first thing on Monday at 6:30am (if the patient can wait a few days).
   • Note that if it’s the weekend and it seems that the patient cannot wait until Monday, consider performing a “medium volume paracentesis” and taking off ~3L for symptomatic relief until their can get the large-volume paracentesis on Monday.

Addition Notes:

• Albumin: Radiology will take care of administering albumin if indicated and arranging for follow-up with hepatology, all we have to do is get the patient to them. If it's the weekend and the hospitalist procedure team performs the paracentesis, the correct albumin dose is found on a standalone "Paracentesis" PowerPlan. In this scenario, follow up can be arranged by us for the Post Discharge Clinic.