Management of Malignancy-related Ascites

Anne Marie C. Flaherty, MSN, RN, APNc, AOCNS®

Disclosures

Oncol Nurs Forum. 2015;42(1):96-99. 

In This Article

Nursing Management With Peritoneal Catheters

Large-volume paracenteses on an outpatient basis can provide adequate management for patients with poor performance status and limited life span (Runyon, 2014). Certain conditions occur when an indwelling peritoneal catheter is contraindicated, including presence of infection or peritonitis, significant coagulopathy, loculated ascites, poor patient and family compliance, and financial constraints (Bard Access Systems, 2012). Each company, however, does have a patient-assistance program. Patient selection is based on absence of contraindications, fair performance status to undergo the procedure, and life expectancy beyond a few weeks.

When a patient requires a weekly paracentesis, the indwelling peritoneal catheter is an option to reduce the trips to the outpatient facility, eliminate the pain associated with the procedure, and provide autonomy to the patient for drainage at his or her convenience. The other positive aspect is that the every-other-day drainage at home allows for small but frequent drainage. This allows a residual amount of ascites to act as a girdle to prevent the rebound reaccumulation of ascites that occurs after a traditional large-volume paracentesis. This can result in less protein loss and hemodynamic fluctuations (Mullard, Bishop, & Jibani, 2011). The recommended drainage schedule is 1–2 L every other day for those patients performing drainage at home (CareFusion, 2014). The infection rate with these catheters is less than 5% (Courtney et al., 2008).

Patient education is a crucial element to the success of managing malignant ascites at home. Coordination of the insurance approval, insertion, procurement of supplies, and adequate support with home care require a team designated to providing these services. Preprocedure instructions and laboratory assessments as well as insurance approval will expedite insertion of the catheter. Home care follow-up and coordination of delivery of supplies are needed to ensure that the patient and caregiver can safely perform home drainage. Both drainage systems provide detailed patient instructions and visuals as well as videos to assist in patient education. Figure 4 lists resources for healthcare professionals and patients to assist with education, procurement of supplies, and visual aids. Oncology nurses are responsible for ensuring that patients and caregivers are adequately educated so that they are able to manage the catheter and drainage of ascites at home.

Figure 4.

Resource Information

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