Large-volume paracentesis in the management of ascites in children

Background: Large-volume paracentesis has been evaluated for both therapeut ic and diagnostic purposes in the management of ascites in cirrhotic adults . There are no published data relating to the safety, efficacy, or methods of this procedure in children. The objective of this study was to character ize the authors' initial experience with large-volume paracentesis (> 50 ml /kg of ascites) for removal of tense abdominal ascites in the pediatric pop ulation. Methods: Retrospective chart review was performed of 21 large-volume parace ntesis sessions in seven children (ages 6 months-18 years) with tense ascit es that did not respond to other measures. Results: Mean volume removed was 3,129 +/- 2,966 ml (mean standard deviatio n) or 118 +/- 56 ml/kg over 2.9 +/- 3.7 hours by a 16-gauge intravascular c atheter in 6 sessions, by an 18-gauge intravascular catheter in three sessi ons, and by a 15-gauge fenestrated, stainless-steel paracentesis needle in 12 sessions. Large-volume paracenteses performed with the paracentesis need le had significantly shorter duration of drainage and faster flow rates tha n those performed with the intravascular catheter. The only complication en countered was decreased urine output in one session. Conclusions: Large-volume paracentesis is a safe and effective therapeutic method for managing tense abdominal ascites in children. The use of the par acentesis needle significantly improved the speed and efficiency of large-v olume paracentesis compared with the intravascular catheter.