Department of Gastroenterology and Hepatology, Carl. T. Hayden VA Medical Center, Phoenix, Arizona 85012, USA.
Ann Hepatol. 2009 Oct-Dec;8(4):359-63.
Due to time constraints, fewer physicians are performing large volume paracentesis (LVP) resulting in a longer wait time and more emergency department (ED) and hospital admissions. At our institution, after initial supervision, a certified nurse practitioner (NP) has independently performed LVP in a dedicated cirrhosis clinic. The purpose of our study was to evaluate the feasibility and safety of LVP performed by a NP. A retrospective review of patients undergoing LVP between January 2003 and May 2007 was performed. Baseline patient information and the practitioner performing LVP (physician or NP) were recorded. Complications including post paracentesis hypotension, bleeding, local leakage of ascitic fluid, infection, perforation, and death were compared between the two groups. A total of 245 procedures in 41 patients were performed by a single NP, and 244 in 43 patients by physicians. Baseline characteristics of patients undergoing LVP were similar in two groups. Alcohol was the most common etiology of cirrhosis (46% in NP and 51% in physician group) followed by a combination of alcohol plus HCV (37% in NP and 28% in physician group). There was similar distribution of Childs class B and C patients in the two groups, as well as average MELD score. Total volume of ascites removed, number of needle attempts, and complications including post paracentesis hypotension, local leakage of ascitic fluid, bleeding, infection, and death were not statistically different between the two groups. Our study shows no difference between physician and NP performance of LVP and complication rates. LVP performed by a NP is feasible and has acceptable rate of complications.
由于时间限制，进行大量腹腔穿刺术（LVP）的医生较少，导致等待时间延长，更多患者需要急诊就诊和住院。在我们的机构，在最初的监督之后，一名经过认证的护士从业者（NP）已在专门的肝硬化诊所独立进行 LVP。我们研究的目的是评估 NP 进行 LVP 的可行性和安全性。回顾性分析了 2003 年 1 月至 2007 年 5 月期间进行 LVP 的患者。记录了患者的基线信息和进行 LVP 的医生或 NP。比较了两组患者发生的并发症，包括穿刺后低血压、出血、腹水局部渗漏、感染、穿孔和死亡。一名 NP 共进行了 41 名患者的 245 次 LVP，医生进行了 43 名患者的 244 次 LVP。两组患者进行 LVP 的基线特征相似。酒精是肝硬化的最常见病因（NP 组为 46%，医生组为 51%），其次是酒精加 HCV 的组合（NP 组为 37%，医生组为 28%）。两组患者的 Childs B 和 C 级患者分布相似，平均 MELD 评分也相似。两组患者的腹水清除总量、穿刺次数以及包括穿刺后低血压、腹水局部渗漏、出血、感染和死亡在内的并发症发生率均无统计学差异。我们的研究表明，医生和 NP 进行 LVP 的操作和并发症发生率没有差异。NP 进行 LVP 是可行的，且具有可接受的并发症发生率。
