Ultrasound guided malignant ascites drainage - A unique multi-professional approach
Laura Laver, Ultrasound, The Great Western Hospital NHS Foundation Trust
During 2007 to 2008, malignant ascites accounted for over 28,000 bed days in hospital in England (HES statistics). There is no evidence in favour of any specific drainage technique, however malignant ascites drainage is most commonly performed on day-case or inpatient basis. Patients often wait until fluid accumulation is substantial to avoid frequent hospital stays… resulting in a deterioration of their quality of life (Stukan 2017).
The Radiology department at GWH wished to address this issue aiming to improve End of Life (EOL) care. A self-referral out-patient malignant ascites drainage service was introduced, enabling the patient to contact the Radiology department directly and arrange an appointment at their convenience. In order for the service to be flexible it has seen the successful training of both nursing and sonography colleagues to perform ultrasound guided paracentesis using aseptic non-touch technique.
There is paucity of reliable evidence regarding the optimum method of managing malignant ascites either at initial presentation, during treatment or palliation. (RCOG No.45). At the GWH the service involves ultrasound guided siting, the ascites is then manually drained by syringe before removal of the cannula, this requires the patient to be in the department for only a few hours.
The service offers an improvement in end of life care by being flexible, efficient and personable. The outpatient service reduces patient time in hospital resulting in a decrease in exposure to healthcare acquired infections.
The estimated cost of day patient paracentesis was £954, compared with £1473 for in-patient paracentesis. The estimated cost to perform ultrasound guided malignant ascites drainage with mechanical aspiration is approximately £805. This results in a saving of £668 per patient. The impact on hospital wards or day case units is also reduced.