COMPARISON OF THE CALDWELL NEEDLE CANNULA WITH ANGIOCATH NEEDLE IN LARGE-VOLUME PARACENTESIS/

Objective: To evaluate the efficacy and safety of a newly designed par acentesis needle, the Caldwell needle/cannula (CNC), and to compare it with the Angiocath needle for large volume paracentesis (LVP), Method s: Forty patients (ages, 18-75 yr) with symptomatic nonmalignant ascit es and serum creatinines < 1.6 were randomized to undergo LVP with eit her the 15-gauge CNC or the 14-gauge Angiocath needle, LVP was conside red complete when the ascitic fluid was believed to have been complete ly removed, a goal of 6 L was attained, or fluid return was poor despi te clinically obvious ascites, Outcome parameters measured included ti me necessary for the LVP, amount of ascitic fluid removed, number of p eritoneal punctures, and the reason for termination of LVP, Ascitic fl uid from eight patients was used to measure in vitro flow rates for bo th needles at -80, -120, and -200 mm Hg, Results: Twenty patients unde rwent LVP with the CNC and 20 with the Angiocath, Patients in whom the CNC was used had significantly faster paracenteses (17.0 +/- 0.8 vs, 34.1 +/- 1.5 min) and required fewer second peritoneal punctures (1 vs , 6, p = 0.046), Fewer LVPs in the CNC group were terminated secondary to poor fluid return (8 vs, 1, p = 0.022), The volume of fluid remove d was greater with the CNC than with the Angiocath, but this differenc e did not reach statistical significance (5205 +/- 209 vs, 4683 +/- 26 9 mi, p = 0.079), There were no complications in either group, In vitr o flow rates were 2.2-3.8 times faster through the CNC than through th e Angiocath at all pressures tested (p < 0.05 for all groups), Conclus ions: The CNC provides a faster, more complete paracentesis requiring fewer peritoneal punctures than a single-bore needle.