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BackTable / VI / Podcast / Episode #87
Deep Dive Into Ascites
with Dr. Rajeev Suri
Interventional Radiologist Rajeev Suri from UT Health San Antonio tells us about his clinical approach to the high-volume ascites patient, including paracentesis technique and tips, albumin regimen, and discussing the need for TIPS in some patients.
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BackTable, LLC (Producer). (2020, October 6). Ep. 87 – Deep Dive Into Ascites [Audio podcast]. Retrieved from https://www.backtable.com
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Podcast Contributors
Dr. Rajeev Suri
Dr. Rajeev Suri is a practicing Interventional Radiologist and a professor of Radiology at UT Health San Antonio.
Dr. Christopher Beck
Dr. Chris Beck is a practicing interventional radiologist with Regional Radiology Group in New Orleans.
Synopsis
In this episode, Dr. Rajeev Suri joins Dr. Christopher Beck to discuss ascites and paracentesis. Dr. Suri touches on what a potential paracentesis candidate might present with and speaks about why no lab values or blood tests are needed prior to the procedure.
We discuss the basic steps for removing ascites, how to find the side with the biggest pocket, and preventing leakage by using a Z pattern. He speaks to the circumstances for using direct US guidance rather than intermittent and when, if ever, to use glue or stitches after paracentesis.
We mention the benefits of utilizing the Renova Pump for fluid removal and discuss why Dr. Suri might use a vacuum container bottle rather than a wall suction. Lastly, we examine some methods for managing recurring patients in the ascites clinic. Dr. Suri also discusses how his practice has incorporated a paracentesis clinic to reduce the number of emergency room visits for ascites and how this practice has improved workflow and patient access to an interventional radiologist.
Resources
Procedure Guide: Paracentesis
https://www.backtable.com/shows/vi/topics/procedure/paracentesis
RenovaRP® Paracentesis Management System
www.rethinkparas.com
This website allows you to download the case study mentioned by Dr. Beck and check out other products from GI Supply.
AASLD Guidelines
https://www.aasld.org/publications/practice-guidelines
This website includes the 2013 guidelines for ascites management.
SIR Coagulation Guidelines
https://www.jvir.org/article/S1051-0443(19)30407-5/pdf
This pdf has recommendations for periprocedural management of thrombotic and bleeding risks in patients.
Denver Shunts
https://www.ajronline.org/doi/full/10.2214/AJR.12.9203
This article, mentioned by Dr. Suri, discusses the placement and management of Denver shunts for portal hypertensice ascites.
Transcript Preview
[Rajeev Suri]
Sure. I understand that. So the concept is that, if you went straight into the peritoneal cavity at a 90 degree angle to the skin, perpendicular, as you're pulling the needle out after a paracentesis, the fluid will leak along the track. So the recommended thing is that if you went through the soft tissue or the subcutaneous tissues in a Z pattern, so that means going forward, slightly back, and then going forward against almost like a Z, you are creating trap doors that would prevent fluid from leaking out along the track. So if you access the subcutaneous soft tissues at a 45 degree angle and then you pull the skin down, say quarterly towards the feet, you are creating the backward bend of the Z at that time as you advance the needle into the peritoneal cavity. And then obviously, when you release the skin pressure on the tag, what you'd pull down, the catheter goes into the peritoneal cavity, but it's created a Z along the soft tissue track.
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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