Therapeutic Paracentesis: Refractory Ascites (Nursing)

00:00 The refractory ascites is a ascites that is unresponsive to the common treatment.

00:05 So when we try sodium restriction diet and a high dose diuretic and it doesn't work.

00:11 We don't decrease the amount of ascites or get it to a manageable level that's considered refractory ascites.

00:18 Because it's going to pop right back up after paracentesis.

00:22 So we try the diet, we try the diuretics that didn't work.

00:25 We try the paracentesis, we pull off a fair amount of fluid and then it just fills right back up after the paracentesis.

00:34 That's the definition of refractory ascites and this has significant impact on quality of life.

00:40 I'm going to give you an even better picture way to think about refractory ascites.

00:46 There's our picture of ascites the ocean of blue, you see the tubing that leads to the drainage container.

00:51 This is a fairly rare occurrence since less than 10% of patients with cirrhosis and ascites develop into liver refractory ascites, okay.

01:02 So we're talking about a fairly rare occurrence, but when it happens, it's a big deal.

01:08 We've got multiple cups there to remind you.

01:10 They're putting out large volumes.

01:13 Let me give you some actual numbers to understand when I say large volumes how big I mean? These patients with refractory ascites accumulate as much as 10 to 15 liters of ascites every 15 days.

01:29 10 to 15 liters every 15 days.

01:31 So just a smidgen over two weeks.

01:35 You're now carrying around, seven and a half two liter bottles of Diet Mountain Dew worth of fluid in your abdomen.

01:44 Can you imagine how that would impact your quality of life.

01:47 Your ability to drive your ability to walk your energy.

01:51 This is a huge deal to the patient that's experiencing it.

01:55 So while we may not see it very often when we do this requires the whole team to collaborate and help the patient deal with it.