Different timing for abdominal paracentesis catheter placement and drainage in severe acute pancreatitis complicated by intraabdominal fluid accumulation

BACKGROUND Non-surgical methods such as percutaneous drainage are crucial for the treatment of patients with severe acute pancreatitis(SAP).However,there is still an ongoing debate regarding the optimal timing for abdominal paracentesis catheter place-ment and drainage.AIM To explore the influence of different timing for abdominal paracentesis catheter placement and drainage in SAP complicated by intra-abdominal fluid accumu-lation.METHODS Using a retrospective approach,184 cases of SAP complicated by intra-abdominal fluid accumulation were enrolled and categorized into three groups based on the timing of catheter placement:group A(catheter placement within 2 d of symptom onset,n=89),group B(catheter placement between days 3 and 5 after symptom onset,n=55),and group C(catheter placement between days 6 and 7 after symptom onset,n=40).The differences in progression rate,mortality rate,and the number of cases with organ dysfunction were compared among the three groups.RESULTS The progression rate of group A was significantly lower than those in groups B and groups C(2.25%vs 21.82%and 32.50%,P<0.05).Further,the proportion of patients with at least one organ dysfunction in group A was significantly lower than those in groups B and groups C(41.57%vs 70.91%and 75.00%,P<0.05).The mortality rates in group A,group B,and group C were similar(P>0.05).At postoperative day 3,the levels of C-reactive protein(55.41±19.32 mg/L vs 82.25±20.41 mg/L and 88.65±19.14 mg/L,P<0.05),procalcitonin(1.36±0.51 ng/mL vs 3.20±0.97 ng/mL and 3.41±0.98 ng/mL,P<0.05),tumor necrosis factor-alpha(15.12±6.63 pg/L vs 22.26±9.96 pg/L and 23.39±9.12 pg/L,P<0.05),interleukin-6(332.14±90.16 ng/L vs 412.20±88.50 ng/L and 420.08±87.65ng/L,P<0.05),interleukin-8(415.54±68.43 ng/L vs 505.80±66.90 ng/L and 510.43±68.23ng/L,P<0.05)and serum amyloid A(270.06±78.49 mg/L vs 344.41±81.96 mg/L and 350.60±80.42 mg/L,P<0.05)were significantly lower in group A compared to those in groups B and group C.The length of hospital stay in group A was significantly lower than those in groups B and group C(24.50±4.16 d vs 35.54±6.62 d and 38.89±7.10 d,P<0.05).The hospitalization expenses in group A were also significantly lower than those in groups B and groups C[2.70(1.20,3.55)ten-thousand-yuan vs 5.50(2.98,7.12)ten-thousand-yuan and 6.00(3.10,8.05)ten-thousand-yuan,P<0.05).The incidence of complications in group A was markedly lower than that in group C(5.62%vs 25.00%,P<0.05),and similar to group B(P>0.05).CONCLUSION Percutaneous catheter drainage for the treatment of SAP complicated by intra-abdominal fluid accumulation is most effective when performed within 2 d of onset.

The Impact of Patient Education on the Nursing Care of Perioperative Patients in the Interventional Catheterization Room

Objective:To explore and analyze the effect of implementing a precise education model on the nursing care of perioperative patients in the interventional catheterization room.Methods:We selected 70 patients who were going to undergo surgical intervention in our hospital from August 2020 to December 2022 as the subjects for this study through random sampling.The patients were divided into a control group and an observation group,with 35 cases in each group.The control group underwent basic nursing intervention,and the observation group was given precise patient education.The nursing effects of both groups were observed.Results:After the intervention,all compliance indicators of the observation group were better than those of the control group(P<0.05).Besides,the incidence of complications in the observation group(2.86%)was lower than that of the control group(17.14%)with P<0.05.Furthermore,the patient satisfaction of the observation group(97.14%)was higher than that of the control group(82.86%),with P<0.05.Conclusion:A precise propaganda and education model facilitates the nursing of perioperative patients in the interventional catheterization room.Therefore,this practice should be popularized.

Anatomical variation in the internal jugular vein:potential risk factors for central venous catheterization-a case report

Central venous catheterization(CVC)is an invasive medical procedure used to measure central venous pressure and provides a stable route for continuous drug administration.CVC is widely used in the emergency department and intensive care units.It is typically performed by inserting a catheter through the internal jugular vein(IJV)into the superior vena cava near the right atrium.[1,2]While catheterization is a fundamental skill proficiently performed by healthcare professionals,lethal complications may occasionally occur because of undesirable positioning,depth and diameter.

How to manage the malposition of deep vein catheterization into the artery?

Central venous catheterization establishes temporary,efficient,and rapid use of deep venous access in patients,which provides high flow rate fluid perfusion,enables measurement of central venous pressure,and acts as an important reference for clinical decision-making.However,various complications such as pneumothorax,hemothorax,hematoma,and puncture failure can easily occur during the puncture and catheterization process.

Analysis of the Nursing Effect of Hierarchical Extended Nursing Based on The Guidance of Orem’s Theory in Patients with PICC Catheterization

Objective:To analyze the nursing effect of hierarchical extended nursing based on the guidance of Orem’s theory in patients with peripherally inserted central(PICC)catheterization.Methods:Ninety-one patients with PICC catheterization admitted to the hospital from May 2021 to May 2023 were selected and divided into a control group and an observation group,with 45 and 46 cases,respectively.The control group received routine nursing care,while the observation group received routine nursing care combined with hierarchical extended nursing based on the guidance of Orem’s theory for 3 months.Relevant indicators between the two groups were compared.Results:The improvement degree of various indicators in the observation group after nursing was better than that of the control group(P<0.05).Conclusion:Graded extended nursing based on the guidance of Orem’s theory improved the knowledge,belief,behavior,and self-efficacy of patients with PICC catheterization,and relieved their anxiety,depression,and other negative emotions.The nursing effect was deemed to be significant.

Pulmonary arterial hypertension confirmed by right heart catheterization following COVID-19 pneumonia: A case report and review of literature

BACKGROUND Pulmonary arterial hypertension(PAH)is a disease of the arterioles resulting in an increased resistance in pulmonary circulation with associated high pressures in the pulmonary arteries,causing irreversible remodeling of the pulmonary arterial walls.Coronavirus disease 2019(COVID-19)has been associated with development of new onset PAH in the literature leading to symptoms of dyspnea,cough and fatigue that persist in spite of resolution of acute COVID-19 infection.However,the majority of these cases of COVID related PAH were diagnosed using echocardiographic data or via right heart catheterization in mechanically ventilated patients.CASE SUMMARY Our case is the first reported case of COVID related PAH diagnosed by right heart catheterization in a non-mechanically ventilated patient.Right heart catheterization has been the gold standard for diagnosis of pulmonary hypertension.Our patient had right heart catheterization four months after her initial COVID-19 infection due to persistent dyspnea.CONCLUSION This revealed new onset PAH that developed following her infection with COVID-19,an emerging sequela of the infection.

Development and validation of a risk prediction model for repeated indwelling urinary catheterization in patients with cervical cancer after surgery

Objective:To study the factors influencing secondary indwelling catheterisation after cervical cancer surgery and to develop a predictive risk model.Methods:A total of 260 patients in a tertiary hospital in Chongqing were selected from January 2020 to December 2021 via convenience sampling.Relevant information of patients was recorded,including age;body mass index;history of hypertension and diabetes,bladder dysfunction,postoperative urinary retention,and postoperative urinary tract infection;Histology;staging;surgical approach;Operation time;Time of first remove of catheter;indwelling catheter days;Hospitalization days.Least absolute shrinkage and selection operator was used to reduce dimensionality and select patient characteristics,and multivariate analysis was performed based on the selected variables.Based on the outcome of analysis,a line chart model was developed for predicting the risk of secondary catheterization in patients with indwelling catheterization after radical cervical cancer surgery.The coefficient of conformity index(C-index)and calibration curves were used to evaluate the accuracy and fit.The model was internally validated via bootstrapping(1000 random samples),and the clinical utility of the model was assessed via decision curve analysis(DCA).Results:Four characteristic variables were selected,including preoperative bladder function,postoperative urinary tract infection,surgical approach,and Time of first remove of catheter.They are independent risk factors affecting urinary tract.The risk prediction model exhibited good discrimination performance with a C-index of 0.722(95%CI,0.661-0.783)and was well calibrated.The C-index was 0.708 in internal validation analysis.DCA showed that the risk model was clinically useful for predicting secondary catheterization,and clinical benefits were observed at the decision threshold of≥11%.Conclusion:A novel model was developed to predict the risk of secondary catheterization.The model was based on preoperative bladder dysfunction,postoperative urinary tract infection,surgical approach,and number of days since the removal of the primary catheter.

Place of Selective Tubal Catheterization in the Management of Female Infertility in Togo

Objective: To determine the effectiveness of selective tubal catheterization in the management of female infertility due to proximal tubal obstruction. Method: This was a longitudinal descriptive study, conducted over a period of 24 months, which included 73 patients presenting with objectified bilateral proximal tubal obstruction after standard HSG. The intervention was performed on an outpatient basis, during the follicular phase with negative β-hCG assay the day before, in the interventional radiology room and under antibiotic coverage. Confirmatory hysterosalpingography was performed as the first step followed by selective tubal catheterization after the failure of spontaneous tubal opacification. The parameters studied related to socio-epidemiological, clinical and radiological data. Results: The age of our patients was between 24 and 42 years with an average of 33.97 years. The average duration of infertility was 3.95 years, with a predominance of primary infertility in 83.56% of cases. Voluntary termination of pregnancy (38.89%) and fibromyomas (33.33%) were the most represented gynecological-obstetrical antecedents. Selective tubal catheterization was successful in 92.14% of cases (129/140 tubes). It was possible bilaterally in 93.02% of cases and unilaterally in 6.98% of cases. The confirmatory HSG allowed a spontaneous opacification of 4.10% of the fallopian tubes. At the end of the procedure, all the recanalized tubes were opacified;62.01% of them were normal, against 37.99% pathological with a preponderance of inflammatory tubes 26.61% followed by hydrosalpinx in 5.03% of cases. No major complications were encountered. The fertility rate was 23.29%. Conclusion: Selective tubal catheterization is a simple technique, without major complications with an efficiency close to natural fertility. It should be proposed as the first intention before any other procedure in the treatment of infertility by proximal tubal obstruction.

Early Cardiac Catheterizations within 30 Days Post Congenital Heart Surgery in Children

Background:This study set out to assess the indications,feasibility,safety,and outcome of early cardiac catheterizations(CC)within 30 days after congenital heart surgery(CHS)in children.Methods and Results:This is a retrospective,single-center case review study of all CC within 30 days after CHS between 1/2010-12/2020.A total of 317(138 diagnostic,179 interventional)CC were performed in 245 patients at a median of 4 days(IQR 13)after CHS.The median age was 3 months(IQR 6),and body weight was 5 kg(IQR 4).A total of 194(61.2%)CC were performed in patients with univentricular hearts.CC revealed significant pathologies leading to early redo-surgery in 37 patients(12%).The transcatheter interventions primarily were needed in patients after cavo-pulmonary connection(n=69%,21.8%),right ventricle to pulmonary artery conduit(n=39%,12.3%),and Norwood-I surgery(n=34%,10.7%)presenting with hypoxemia,prolonged postoperative course,and suspected arterial stenosis on echocardiography.The clinical impact of an early postoperative transcatheter intervention for the following clinical course was high in most cases.There were nine(2.8%)major and 20(6.3%)minor intra-procedural complications.Risk factor analysis revealed no difference for the occurrence of complications for patients’age,weight,and time from initial CHS,underlying uni-vs.biventricular heart disease,or ECMO.Conclusion:Early CC within 30 days after CHS in children can be performed safely with a high diagnostic and therapeutic value.The rate of complications is low,while the therapeutic consequence is relevant.

Effects of General Anesthesia on the Results of Cardiac Catheterization in Pediatric Patients with Ventricular Septal Defect

Background:There is no gold standard sedation method for pediatric cardiac catheterization.In congenital heart diseases with intracardiac shunts,hemodynamic parameters are prone to change depending on the ventilation conditions and anesthetics,although few studies have examined these effects.The purpose of this study was to investigate the effects of two different sedation methods on the hemodynamic parameters.Methods:This study retrospectively evaluated consecutive patients with ventricular septal defect(VSD)below 1 year of age who underwent cardiac catheterization at Aichi Children’s Health and Medical Center,who were divided into age-and VSD diameter-matched general anesthesia(GA)and monitored anesthesia care(MAC)under the natural airway groups(n=40 each),for comparison of hemodynamic parameters.Results:In the GA group,arterial blood pH and arterial partial pressure of oxygen were significantly higher(p<0.01),whereas arterial partial pressure of carbon dioxide was significantly lower than in the MAC group(p<0.01).Mean pulmonary artery pressure(p<0.05)and systemic blood pressure(p<0.01)were lower in the GA group.Pulmonary vascular resistance index(p<0.01)and systemic vascular resistance index(p<0.01)were also significantly lower in the GA group than the MAC group.There were no significant differences in pulmonary blood flow index,systemic blood flow index,and pulmonary/systemic blood flow ratio between the two groups.Conclusions:Cardiac catheterization under GA in VSD patients results in different hemodynamic parameters compared to that under MAC.In particular,when using pulmonary artery pressure and pulmonary vascular resistance measured under GA for judgment regarding the surgical indications or perioperative management,consideration should be given to the fact that these parameters might be lower compared to those measured under MAC.

Iatrogenic bladder neck rupture due to traumatic urethral catheterization: A case report

BACKGROUND In this article,we present a case of iatrogenic bladder neck rupture due to catheter insertion in a 94-year-old comorbid male patient.CASE SUMMARY The patient,who had a urethral catheter inserted in the palliative service 3 d ago,was consulted because the catheter did not work.Because the fluid given to the bladder could not be recovered,computed tomography was performed,which revealed that the catheter had passed the bladder neck first into the retrovesical area then into the intraabdominal area.The appearance of the anterior urethra and verumontanum was normal at cystoscopy.However,extremely severe stenosis of the bladder neck,and perforated posterior wall of the urethral segment between the prostatic urethra and the bladder neck were observed.Internal urethrotomy was applied to the bladder neck with a urethrotome.An urethral catheter was sent over the guide wire into the bladder.The patient was followed in the palliative care service and the catheter was removed 7 d later.No extravasation was observed in the control urethrography.CONCLUSION Although catheter insertion is a simple and frequently performed procedure in hospitalized patients,it is necessary to avoid unnecessary extra-indication catheter insertion.

Median neuropathy after multiple punctures of the forearm for catheterization:A case report

BACKGROUND Neuropathy may occur at some sites after catheterization for close examination of cardiac disease.Although the radial artery is considered a relatively uncomplicated site for catheterization,the radial artery and median nerve are in relatively close proximity,with the risk of median nerve injury depending on the angle of puncture.The purpose of this study was to report the outcomes of surgery performed for conservative therapy-resistant median neuropathy following forearm catheterization.CASE SUMMARY A 50-year-old woman experienced palsy from the right thumb to the radial side of the ring finger after catheterization from the radial artery of the right forearm.Paresthesia developed at the same site and a positive tinel-like sign was seen for the median nerve area at the high level of the puncture site.Nerve conduction study showed reduced compound muscle action potentials and loss of sensory nerve action potentials.Symptoms did not improve despite pharmacotherapy and the patient gradually developed flexion restrictions of the index and middle fingers.Median nerve injury and associated flexor tendon adhesion was diagnosed,and the patient was referred for surgery at 3 mo after injury.When the same area was opened,no injury to the median nerve epithelium was obvious,but the area of the positive tinel-like sign was highly adherent to surrounding tissue and to the flexor digitorum superficialis of the index and middle fingers.The surgery was terminated with adequate adhesion release.Rehabilitation was initiated postoperatively,improving neurological symptoms and range of motion of the fingers.Six months after surgery,the patient returned to daily activities without discomfort.CONCLUSION This case provides the appropriate diagnosis and treatment for a suspected peripheral nerve injury.

Central venous catheterization-related complications in a cohort of 100 hospitalized patients:An observational study

Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically ill patients(aged≥18 years)in the intensive care unit undergoing CVC procedures were included in the study.Baseline demographics and detailed medical history were recorded.Chest X-rays and electrocardiography were performed on all the patients.Complications associated with CVC were recorded.Results:A total of 100 patients with the indication for central venous catheter insertion were included.The majority(81%)of the patients were inserted with CVC at the right internal jugular vein.Complications such as arterial puncture(2%),hematoma(4%),blood clot formation(4%),catheter kinking(3%),thoracic injury(1%),thrombophlebitis(6%),sepsis(9%)and nerve injury(1%)were reported.Conclusions:Though central venous access is preferred in management of critically ill patients,it has its risks.However,early recognition and prompt management of complications may reduce mortality and morbidity.Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications.Suitable site selection,operator experience,and proper catheter maintenance are associated with optimal outcomes.

Timing of paracentesis and outcomes in hospitalized patients with decompensated cirrhosis

BACKGROUND Ascites is one of the most common complications of cirrhosis,placing a significant burden on the healthcare system.Data regarding the optimal time of paracentesis and outcomes among patients with cirrhosis and ascites are scarce.AIM To assess the outcomes of patients who underwent paracentesis within 12 h after admission compared to patients who underwent paracentesis later than 12 h.METHODS The study included 185 patients with cirrhosis and ascites who underwent paracentesis.The early paracentesis group was defined as paracentesis performed<12 h after admission(65 patients)and the delayed paracentesis group was defined as paracentesis performed>12 h after admission(120 patients).Newonset complications of cirrhosis,length of hospital stay,weekday or weekend admission,in-hospital mortality rate,and 90-d readmission rates were assessed and compared between the groups.RESULTS Significantly more patients in the delayed paracentesis group than in the early paracentesis group developed hepatic encephalopathy(45%vs 21.5%,P<0.01),hepato-renal syndrome(21.6%vs 9.2%,P=0.03)and infections(25%vs 10.7%,P=0.02)during hospitalization.There were no statistically significant differences in the occurrence of spontaneous bacterial peritonitis and upper gastrointestinal bleeding between the two groups.Length of stay was shorter in the early paracentesis group than in the delayed paracentesis group(6.7 d vs 12.2 d)and inhospital mortality was lower among patients in the early paracentesis group.Patients in the delayed paracentesis group had a higher risk of developing complications during hospitalization.CONCLUSION Early paracentesis(within 12 h after admission)could be a new inpatient quality metric among patients hospitalized with cirrhosis and ascites as it is associated with fewer complications of cirrhosis,lower in-hospital mortality and shorter length of stay.

Abdominal paracentesis drainage ameliorates severe acute pancreatitis in rats by regulating the polarization of peritoneal macrophages

AIM To investigate the role of peritoneal macrophage(PM) polarization in the therapeutic effect of abdominal paracentesis drainage(APD) on severe acute pancreatitis(SAP).METHODS SAP was induced by 5% Na-taurocholate retrograde injection in Sprague-Dawley rats. APD was performed by inserting a drainage tube with a vacuum ball into the lower right abdomen of the rats immediately after the induction of SAP. To verify the effect of APD on macrophages, PMs were isolated and cultured in an environment, with the peritoneal inflammatory environment simulated by the addition of peritoneal lavage in complete RPMI 1640 medium. Hematoxylin and eosin staining was performed. The levels of pancreatitis biomarkers amylase and lipase as well as the levels of inflammatory mediators in the blood and peritoneal lavage were determined. The polarization phenotypes of the PMs were identified by detecting the marker expression of M1/M2 macrophages via flow cytometry, qPCR and immunohistochemical staining. The protein expression in macrophages that had infiltrated the pancreas was determined by Western blot.RESULTS APD treatment significantly reduced the histopathological scores and levels of amylase, lipase, tumor necrosis factor-α and interleukin(IL)-1β, indicating that APD ameliorates the severity of SAP. Importantly, we found that APD treatment polarized PMs towards the M2 phenotype, as evidenced by the reduced number of M1 macrophages and the reduced levels of proinflammatory mediators, such as IL-1β and L-selectin, as well as the increased number of M2 macrophages and increased levels of anti-inflammatory mediators, such as IL-4 and IL-10. Furthermore, in an in vitro study wherein peritoneal lavage from the APD group was added to the cultured PMs to simulate the peritoneal inflammatory environment, PMs also exhibited a dominant M2 phenotype, resulting in a significantly lower level of inflammation. Finally, APD treatment increased the proportion of M2 macrophages and upregulated the expression of the anti-inflammatory protein Arg-1 in the pancreas of SAP model rats.CONCLUSION These findings suggest that APD treatment exerts antiinflammatory effects by regulating the M2 polarization of PMs, providing novel insights into the mechanism underlying its therapeutic effect.

Abdominal paracentesis drainage ameliorates myocardial injury in severe experimental pancreatitis rats through suppressing oxidative stress

BACKGROUND Abdominal paracentesis drainage(APD)is a safe and effective strategy for severe acute pancreatitis(SAP)patients.However,the effects of APD treatment on SAPassociated cardiac injury remain unknown.AIM To investigate the protective effects of APD on SAP-associated cardiac injury and the underlying mechanisms.METHODS SAP was induced by 5%sodium taurocholate retrograde injection in Sprague-Dawley rats.APD was performed by inserting a drainage tube with a vacuum ball into the lower right abdomen of the rats immediately after SAP induction.Morphological staining,serum amylase and inflammatory mediators,serum and ascites high mobility group box(HMGB)1,cardiac-related enzymes indexes and cardiac function,oxidative stress markers and apoptosis and associated proteins were assessed in the myocardium in SAP rats.Nicotinamide adenine dinucleotide phosphate oxidase activity and mRNA and protein expression were also examined.RESULTS APD treatment improved cardiac morphological changes,inhibited cardiac dysfunction,decreased cardiac enzymes and reduced cardiomyocyte apoptosis,proapoptotic Bax and cleaved caspase-3 protein levels.APD significantly decreased serum levels of HMGB1,inhibited nicotinamide adenine dinucleotide phosphate oxidase expression and ultimately alleviated cardiac oxidative injury.Furthermore,the activation of cardiac nicotinamide adenine dinucleotide phosphate oxidase by pancreatitis-associated ascitic fluid intraperitoneal injection was effectively inhibited by adding anti-HMGB1 neutralizing antibody in rats with mild acute pancreatitis.CONCLUSION APD treatment could exert cardioprotective effects on SAP-associated cardiac injury through suppressing HMGB1-mediated oxidative stress,which may be a novel mechanism behind the effectiveness of APD on SAP.

An automated spring-loaded needle for endoscopic ultrasound-guided abdominal paracentesis in cancer patients

AIM: To evaluate the feasibility of using an automatedspring-loaded needle device for endoscopic ultrasound(EUS)-guided abdominal paracentesis(EUS-P) to see if this would make it easier to puncture the mobile and lax gastric wall for EUS-P.METHODS: The EUS database and electronic medical records at Fukushima Medical University Hospital were searched from January 2001 to April 2011. Patients with a history of cancer and who underwent EUS-P using an automated spring-loaded needle device with a 22-gauge puncture needle were included. The needle was passed through the instrument channel and advanced through the gastrointestinal wall under EUS guidance into the echo-free space in the abdominal cavity and ascitic fluid was collected. The confirmed diagnosis of malignant ascites included positive cytology and results from careful clinical observation for at least 6 mo in patients with negative cytology. The technical success rate, cytology results and complications were evaluated.RESULTS: We found 11 patients who underwent EUS-P with an automated spring-loaded needle device. In 4 cases, ascites was revealed only with EUS but not in other imaging modalities. EUS-P was done in 7 other cases because there was minimal ascitic fluid and no safe window for percutaneous abdominal aspiration. Ascitic fluid was obtained in all cases by EUS-P. The average amount aspirated was 14.1 mL(range 0.5-38 mL) and that was sent for cytological exam. The etiology of ascitic fluid was benign in 5 patients and malignant in 6. In all cases, ascitic fluid was obtained with the first needle pass. No procedure-related adverse effects occurred.CONCLUSION: EUS-P with an automated springloaded needle device is a feasible and safe method for ascites evaluation.

Paracentesis in cirrhotics is associated with increased risk of 30-day readmission

AIM To determine the readmission rate, its reasons, predictors, and cost of 30-d readmission in patients with cirrhosis and ascites.METHODS A retrospective analysis of the nationwide readmission database(NRD) was performed during the calendar year 2013. All adults cirrhotics with a diagnosis of ascites,spontaneous bacterial peritonitis, or hepatic encephalopathy were identified by ICD-9 codes. Multivariate analysis was performed to assess predictors of 30-d readmission and cost of readmission.RESULTS Of the 59597 patients included in this study, 18319(31%) were readmitted within 30 d. Majority(58%) of readmissions were for liver related reasons. Paracentesis was performed in 29832(50%) patients on index admission. Independent predictors of 30-d readmission included age < 40(OR: 1.39; CI: 1.19-1.64), age 40-64(OR: 1.19; CI: 1.09-1.30), Medicaid(OR: 1.21; CI: 1.04-1.41) and Medicare coverage(OR: 1.13; CI: 1.02-1.26), > 3 Elixhauser comorbidity(OR: 1.13; CI: 1.05-1.22), nonalcoholic cirrhosis(OR: 1.16; CI: 1.10-1.23), paracentesis on index admission(OR: 1.28; CI: 1.21-1.36) and having hepatocellular carcinoma(OR: 1.21; CI: 1.05; 1.39). Cost of index admission was similar in patients readmitted and not readmitted(P-value: 0.34); however cost of care was significantly more on 30 d readmission($30959 ± 762) as compared to index admission($12403 ± 378), P-value: < 0.001.CONCLUSION Cirrhotic patients with ascites have a 33% chance of readmission within 30-d. Younger patients, with public insurance, nonalcoholic cirrhosis and increased comorbidity who underwent paracentesis are at increased risk of readmission. Risk factors for unplanned readmission should be targeted given these patients have higher healthcare utilization.

Ultrasound for Detection of Ascites and for Guidance of the Paracentesis Procedure: Technique and Review of the Literature

Objective: To review the use of ultrasound (US) for the detection of free intraperitoneal fluid (ascites) and for the procedural guidance of the paracentesis procedure. Methods: Two clinical vignettes are presented to review the pertinent diagnostic, management and safety considerations associated with paracentesis. First, US techniques used for the identification of ascites and in the quantification of fluid pockets amenable to aspiration will be discussed. Next, the actual steps required for the performance of US-guided paracentesis will be covered. A review and analysis of the most current literature regarding US and paracentesis then follows. Conclusion: Current literature favors US-guided paracentesis over the traditional blind technique with a significant reduction in both the rate of unsuccessful aspiration of fluid and in the bleeding complications related to this procedure. Use of US for both the diagnostic and therapeutic management of ascites should be advocated as an essential skill for physicians and other health care providers caring for these patients.

Abdominal paracentesis drainage attenuates intestinal inflammation in rats with severe acute pancreatitis by inhibiting the HMGB1-mediated TLR4 signaling pathway

BACKGROUND Our previous studies confirmed that abdominal paracentesis drainage(APD)attenuates intestinal mucosal injury in rats with severe acute pancreatitis(SAP),and improves administration of enteral nutrition in patients with acute pancreatitis(AP).However,the underlying mechanisms of the beneficial effects of APD remain poorly understood.AIM To evaluate the effect of APD on intestinal inflammation and accompanying apoptosis induced by SAP in rats,and its potential mechanisms.METHODS SAP was induced in male adult Sprague-Dawley rats by 5%sodium taurocholate.Mild AP was induced by intraperitoneal injections of cerulein(20μg/kg body weight,six consecutive injections).Following SAP induction,a drainage tube connected to a vacuum ball was placed into the lower right abdomen of the rats to build APD.Morphological changes,serum inflammatory mediators,serum and ascites high mobility group box protein 1(HMGB1),intestinal barrier function indices,apoptosis and associated proteins,and toll-like receptor 4(TLR4)signaling molecules in intestinal tissue were assessed.RESULTS APD significantly alleviated intestinal mucosal injury induced by SAP,as demonstrated by decreased pathological scores,serum levels of D-lactate,diamine oxidase and endotoxin.APD reduced intestinal inflammation and accompanying apoptosis of mucosal cells,and normalized the expression of apoptosis-associated proteins in intestinal tissues.APD significantly suppressed activation of the intestinal TLR4 signaling pathway mediated by HMGB1,thus exerting protective effects against SAP-associated intestinal injury.CONCLUSION APD improved intestinal barrier function,intestinal inflammatory response and accompanying mucosal cell apoptosis in SAP rats.The beneficial effects are potentially due to inhibition of HMGB1-mediated TLR4 signaling.