RESUMO
Introducción: la ascitis refractaria puede ser una complicación frecuente en el síndrome nefrótico (SN), existen casos reportados del uso de un catéter tunelizado de diálisis peritoneal en pacientes con cirrosis o neoplasias abdominales. Se presenta el caso de un paciente con SN en quién se utilizó un catéter para diálisis peritoneal (DP) para manejo de la ascitis refractaria. Objetivo: mostrar que el catéter peritoneal puede ser considerado como una alternativa para el manejo de la ascitis refractaria en pacientes con síndrome nefrótico. Presentación del caso: paciente varón de 19 años, sin antecedentes patológicos, cursó con edema progresivo y alteración de la función renal. Se evidenció síndrome nefrótico con anasarca y evolucionó con empeoramiento de la función renal ingresando a hemodiálisis de soporte. Se realizó biopsia renal: podocitopatía, glomerulopatía colapsante. Se inició tratamiento con corticoterapia, mejorando la función renal hasta suspender la hemodiálisis, pero presentó ascitis refractaria al tratamiento médico, por lo que se realizó paracentesis evacuatoria en reiteradas ocasiones. Se decidió colocación de catéter peritoneal tunelizado para el manejo de la ascitis refractaria. La ascitis fue disminuyendo progresivamente hasta el retiro del catéter peritoneal. Discusión y conclusión: el uso de catéter tunelizado de diálisis peritoneal es una opción de manejo efectiva en casos de síndrome nefrótico con ascitis refractaria.
Introduction: Refractory ascites can be a frequent complication in nephrotic syndrome (NS), there are reported cases of the use of a tunneled peritoneal dialysis catheter in patients with cirrhosis or abdominal neoplasms. The case of a patient with NS is presented in whom used a peritoneal dialysis (PD) catheter to manage refractory ascites. Purpose: To show that the peritoneal catheter can be considered as an alternative for the management of refractory ascites in patients with nephrotic syndrome. Presentation of the case: A 19-year-old male patient, with no pathological history, presented progressive edema and impaired renal function. Nephrotic syndrome with anasarca was evidenced, and it evolved with worsening renal function, entering supportive hemodialysis. Renal biopsy was performed: podocytopathy, collapsing glomerulopathy. Corticosteroid treatment was started, improving renal function until hemodialysis was discontinued, but he presented ascites refractory to medical treatment, for which evacuatory paracentesis was performed repeatedly. It was decided to place a tunneled peritoneal catheter for the management of refractory ascites. Ascites gradually decreased until the peritoneal catheter was removed. Discussion and conclusion: The use of a tunneled peritoneal dialysis catheter is an effective management option in cases of nephrotic syndrome with refractory ascites.
RESUMO
Mortality in cirrhosis is mostly associated with the development of clinical decompensation, characterized by ascites, hepatic encephalopathy, variceal bleeding, or jaundice. Therefore, it is important to prevent and manage such complications. Traditionally, the pathophysiology of decompensated cirrhosis was explained by the peripheral arterial vasodilation hypothesis, but it is currently understood that decompensation might also be driven by a systemic inflammatory state (the systemic inflammation hypothesis). Considering its oncotic and nononcotic properties, albumin has been thoroughly evaluated in the prevention and management of several of these decompensating events. There are formal evidence-based recommendations from international medical societies proposing that albumin be administered in individuals with cirrhosis undergoing large-volume paracentesis, patients with spontaneous bacterial peritonitis, those with acute kidney injury (even before the etiological diagnosis), and those with hepatorenal syndrome. Moreover, there are a few randomized controlled trials and meta-analyses suggesting a possible role for albumin infusion in patients with cirrhosis and ascites (long-term albumin administration), individuals with hepatic encephalopathy, and those with acute-on-chronic liver failure undergoing modest-volume paracentesis. Further studies are necessary to elucidate whether albumin administration also benefits patients with cirrhosis and other complications, such as individuals with extraperitoneal infections, those hospitalized with decompensated cirrhosis and hypoalbuminemia, and patients with hyponatremia.
Assuntos
Varizes Esofágicas e Gástricas , Encefalopatia Hepática , Síndrome Hepatorrenal , Peritonite , Albuminas/uso terapêutico , Ascite/tratamento farmacológico , Ascite/terapia , Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/etiologia , Encefalopatia Hepática/tratamento farmacológico , Síndrome Hepatorrenal/etiologia , Humanos , Cirrose Hepática/tratamento farmacológico , Peritonite/microbiologiaRESUMO
Purpose: In non-drainage scleral buckling, anterior chamber paracentesis is usually carried out to decrease intraocular pressure. When the buckling is extensive however, this technique may be inefficient and time consuming. In this study, we tried to determine if a mini 25-gauge pars plana vitrectomy could be used as an efficient and safe alternative procedure to anterior chamber paracentesis for adjusting intraocular pressure during a non-drainage scleral buckling. Methods: In this case series, 44 patients with rhegmatogenous retinal detachment (proliferative vitreoretinopathy stage < C) were included. In all cases, a mini 25-gauge pars plana vitrectomy was performed before buckle fixation and repeated if necessary. Complete retinal attachment was defined as the anatomical success. Results: Forty-four eyes of 44 patients with mean age of 48.1 ± 18.2 years were included. Silicon buckle nº 276, sponge 505, and sponge 507 were utilized for 7, 34, and 3 eyes, respectively. Intravitreal injection of SF6 gas was performed for 54.5% of the eyes. Mean total time of the operation was 61 ± 16 min and the mean time for vitrectomy was 87 ± 31 s. Complete retinal attachment in 37 and incomplete attachment in 4 eyes were achieved after single operation that was a success rate of 93.2%. One had more than usual vitreous leak at the site of scleretomy and one developed a tiny vitreous hemorrhage at the sclerotomy site. Three sclerotomy sites needed suturing. Conclusion: The anatomical outcome and the safety observed in this study were comparable to the current methods reported in the literature. Therefore, if anterior chamber paracentesis fails to adjust intraocular pressure during a non-drainage scleral buckling, performing a small gauge mini vitrectomy is safe and helpful.
Assuntos
Descolamento Retiniano , Recurvamento da Esclera , Adulto , Idoso , Humanos , Pressão Intraocular , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual , VitrectomiaRESUMO
Purpose: In non-drainage scleral buckling, anterior chamber paracentesis is usually carried out to decrease intraocular pressure. When the buckling is extensive however, this technique may be inefficient and time consuming. In this study, we tried to determine if a mini 25-gauge pars plana vitrectomy could be used as an efficient and safe alternative procedure to anterior chamber paracentesis for adjusting intraocular pressure during a non-drainage scleral buckling. Methods: In this case series, 44 patients with rhegmatogenous retinal detachment (proliferative vitreoretinopathy stage < C) were included. In all cases, a mini 25-gauge pars plana vitrectomy was performed before buckle fixation and repeated if necessary. Complete retinal attachment was defined as the anatomical success. Results: Forty-four eyes of 44 patients with mean age of 48.1 ± 18.2 years were included. Silicon buckle nº 276, sponge 505, and sponge 507 were utilized for 7, 34, and 3 eyes, respectively. Intravitreal injection of SF6 gas was performed for 54.5% of the eyes. Mean total time of the operation was 61 ± 16 min and the mean time for vitrectomy was 87 ± 31 s. Complete retinal attachment in 37 and incomplete attachment in 4 eyes were achieved after single operation that was a success rate of 93.2%. One had more than usual vitreous leak at the site of scleretomy and one developed a tiny vitreous hemorrhage at the sclerotomy site. Three sclerotomy sites needed suturing. Conclusion: The anatomical outcome and the safety observed in this study were comparable to the current methods reported in the literature. Therefore, if anterior chamber paracentesis fails to adjust intraocular pressure during a non-drainage scleral buckling, performing a small gauge mini vitrectomy is safe and helpful.
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Recurvamento da Esclera , Descolamento Retiniano , Vitrectomia , Acuidade Visual , Estudos Retrospectivos , Resultado do Tratamento , Pressão IntraocularRESUMO
Cirrhosis is characterised by a prolonged asymptomatic period in which the inflammation persists, increasing as the disease progresses. Characteristic of this is the increase in pro-inflammatory cytokines and pro-oxidant molecules which are determining factors in the development of multiple organ dysfunction. In the early development of cirrhosis, splanchnic arterial vasodilation, activation of vasoconstrictor systems (renin-angiotensin-aldosterone) and the sympathetic nervous system (noradrenaline) bring about bacterial translocation and systemic dissemination via portal circulation of bacterial products, and molecular patterns associated with damage, which exacerbate the systemic inflammation present in the patient with cirrhosis. Albumin is a molecule that undergoes structural and functional changes as liver damage progresses, affecting its antioxidant, immunomodulatory, oncotic and endothelial stabilising properties. Our knowledge of the properties of albumin reveals a molecule with multiple treatment options in patients with cirrhosis, from the compensated then decompensated phases to multiple organ dysfunction. Its recognised uses in spontaneous bacterial peritonitis, post-paracentesis circulatory dysfunction, acute kidney injury and hepatorenal syndrome are fully validated, and a treatment option has opened up in decompensated cirrhosis and in acute-on-chronic liver disease.
Assuntos
Síndrome Hepatorrenal , Peritonite , Albuminas/uso terapêutico , Síndrome Hepatorrenal/diagnóstico , Síndrome Hepatorrenal/etiologia , Humanos , Inflamação , Cirrose Hepática/complicações , Insuficiência de Múltiplos Órgãos/complicações , Peritonite/diagnóstico , Peritonite/tratamento farmacológicoRESUMO
ABSTRACT Objectives: to describe the assembly of a low-cost paracentesis simulator and evaluate its effectiveness, acceptance and impact on the learning of medical students. Methodology: a paracentesis simulator was built using a mannequin and materials such as plastic bottles, Velcro, polyvinyl chloride sheets and silicone were used. A cross-sectional and experimental study was carried out with undergraduate medical students without previous practical experience with paracentesis, which sought to validate the model, evaluating its benefits in learning and obtaining technical skills. Results: after using the simulator there was an increase of 82.4% in the level of confidence in performing paracentesis in a patient, with 98% of respondents considering that the model fulfilled the simulator function with satisfaction, and 100% considering it useful as a teaching tool. Conclusion: the built simulator was effective as an educational resource, serving as an alternative to high-cost commercial models, allowing for greater accessibility in the use of this tool in medical education.
RESUMO Objetivos: descrever a montagem de simulador de paracentese de baixo custo e avaliar eficácia, aceitação e impacto no aprendizado de acadêmicos do curso de medicina. Método: um simulador de paracentese foi construído a partir de manequim e de materiais como garrafas plásticas, velcro, folhas de policloreto de vinila e silicone. Foi feito estudo transversal com estudantes da graduação do curso de medicina sem experiência real prévia com paracentese, que buscou validar o modelo, por meio da análise de benefícios no aprendizado e na obtenção de habilidades técnicas. Resultados: após o uso do simulador, observou-se aumento de 82,4% no nível de segurança na realização da paracentese em paciente, 98% dos pesquisados consideraram que o uso do modelo cumpriu com satisfação a função de simulador e 100% definiram-no útil como ferramenta de ensino. Conclusão: a montagem do simulador mostrou-se factível e eficaz como recurso educacional. Serviu como alternativa aos modelos comerciais de alto custo e permitiu maior acessibilidade do uso dessa ferramenta na educação médica.
Assuntos
Humanos , Estudantes de Medicina , Educação Médica , Ascite/terapia , Ensino , Estudos Transversais , Competência Clínica , Paracentese/educaçãoRESUMO
Ascites is the most common presentation of decompensated liver cirrhosis. It is treated with therapeutic paracentesis which is associated with several complications. The role of human albumin in patients with cirrhotic ascites remains elusive and has been extensively studied with conflicting results. Thus, in order to fully appraise the available data we sought to perform this systematic review and meta-analysis. Herein we included studies comparing the efficacy and safety of human albumin comparing with other volume expanders and vasoactive agents in patients undergoing paracentesis in cirrhotic ascites. Odds ratio (OR) and mean difference (MD) were used to estimate the outcome with a 95% confidence interval (CI). Albumin use reduced the odds of paracentesis induced circulatory dysfunction (PICD) by 60% (OR 0.40, 95% CI 0.27-0.58). While performing subgroup analysis, albumin use lowered the odds of PICD significantly (OR 0.34, 95% CI 0.22-0.52) in comparison to other colloid volume expanders, but did not lower the odds of PICD in comparison to vasoconstrictor therapy (OR 0.93, 95% CI 0.35-2.45). Albumin was associated with a statistically significant lower incidence of hyponatremia (OR 0.59, 95% CI 0.39-0.88). Albumin did not reduce the overall mortality, readmission rate, recurrence of ascites, mean arterial pressure, incidence of renal impairment, hepatic encephalopathy, and gastrointestinal (GI) bleeding. Thus, treatment with albumin in cirrhotic ascites reduced PICD and hyponatremia although there was no benefit in terms of mortality, readmission rate, recurrence of ascites, hepatic encephalopathy, and GI bleeding.
Assuntos
Ascite/terapia , Cirrose Hepática/terapia , Paracentese , Ascite/etiologia , Humanos , Cirrose Hepática/complicações , Albumina Sérica Humana/uso terapêuticoRESUMO
INTRODUCTION AND OBJECTIVES: Weekend admissions has previously been associated with worse outcomes in conditions requiring specialists. Our study aimed to determine in-hospital outcomes in patients with ascites admitted over the weekends versus weekdays. Time to paracentesis from admission was studied as current guidelines recommend paracentesis within 24h for all patients admitted with worsening ascites or signs and symptoms of sepsis/hepatic encephalopathy (HE). PATIENTS: We analyzed 70 million discharges from the 2005-2014 National Inpatient Sample to include all adult patients admitted non-electively for ascites, spontaneous bacterial peritonitis (SBP), and HE with ascites with cirrhosis as a secondary diagnosis. The outcomes were in-hospital mortality, complication rates, and resource utilization. Odds ratios (OR) and means were adjusted for confounders using multivariate regression analysis models. RESULTS: Out of the total 195,083 ascites/SBP/HE-related hospitalizations, 47,383 (24.2%) occurred on weekends. Weekend group had a higher number of patients on Medicare and had higher comorbidity burden. There was no difference in mortality rate, total complication rates, length of stay or total hospitalization charges between the patients admitted on the weekend or weekdays. However, patients admitted over the weekends were less likely to undergo paracentesis (OR 0.89) and paracentesis within 24h of admission (OR 0.71). The mean time to paracentesis was 2.96 days for weekend admissions vs. 2.73 days for weekday admissions. CONCLUSIONS: We observed a statistically significant "weekend effect" in the duration to undergo paracentesis in patients with ascites/SBP/HE-related hospitalizations. However, it did not affect the patient's length of stay, hospitalization charges, and in-hospital mortality.
Assuntos
Plantão Médico/tendências , Ascite/terapia , Cirrose Hepática/terapia , Paracentese/tendências , Admissão do Paciente/tendências , Tempo para o Tratamento/tendências , Plantão Médico/economia , Ascite/diagnóstico , Ascite/economia , Ascite/mortalidade , Bases de Dados Factuais , Feminino , Preços Hospitalares/tendências , Mortalidade Hospitalar/tendências , Humanos , Pacientes Internados , Tempo de Internação , Cirrose Hepática/diagnóstico , Cirrose Hepática/economia , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Paracentese/efeitos adversos , Paracentese/economia , Paracentese/mortalidade , Admissão do Paciente/economia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Tempo para o Tratamento/economia , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
ABSTRACT BACKGROUND: Liver cirrhosis is a highly prevalent disease that, at an advanced stage, usually causes ascites and associated respiratory changes. However, there are few studies evaluating and quantifying the impact of ascites and its relief through paracentesis on lung function and symptoms such as fatigue and dyspnea in cirrhotic patients. OBJECTIVE: To assess and quantify the impact of acute reduction of ascitic volume on respiratory parameters, fatigue and dyspnea symptoms in patients with hepatic cirrhosis, as well as to investigate possible correlations between these parameters. METHODS: Thirty patients with hepatic cirrhosis and ascites who underwent the following pre and post paracentesis evaluations: vital signs, respiratory pattern, thoracoabdominal mobility (cirtometry), pulmonary function (ventilometry), degree of dyspnea (numerical scale) and fatigue level (visual analog scale). RESULTS: There was a higher prevalence of patients classified as CHILD B and the mean MELD score was 14.73±5.75. The comparison of pre and post paracentesis parameters evidenced after paracentesis: increase of predominantly abdominal breathing pattern, improvement of ventilatory variables, increase of the differences obtained in axillary and abdominal cirtometry, reduction of dyspnea and fatigue level, blood pressure reduction and increased peripheral oxygen saturation. Positive correlations found: xiphoid with axillary cirtometry, degree of dyspnea with fatigue level, tidal volume with minute volume, Child "C" with higher MELD score, volume drained in paracentesis with higher MELD score and with Child "C". We also observed a negative correlation between tidal volume and respiratory rate. CONCLUSION: Since ascites drainage in patients with liver cirrhosis improves pulmonary volumes and thoracic expansion as well as reduces symptoms such as fatigue and dyspnea, we can conclude that ascites have a negative respiratory and symptomatological impact in these patients.
RESUMO CONTEXTO: A cirrose hepática é uma doença altamente prevalente que, em estágio avançado, geralmente causa ascite e alterações respiratórias associadas. No entanto, existem poucos estudos avaliando e quantificando o impacto da ascite e do seu alívio através da paracentese na função pulmonar e em sintomas como fadiga e dispneia em pacientes cirróticos. OBJETIVO: Avaliar e quantificar o impacto da redução aguda do volume ascítico nos parâmetros respiratórios, sintomas de fadiga e dispneia em pacientes com cirrose hepática, bem como investigar possíveis correlações entre esses parâmetros. MÉTODOS: Trinta pacientes com cirrose hepática e ascite foram submetidos às seguintes avaliações pré e pós-paracentese: sinais vitais, padrão respiratório, mobilidade toracoabdominal (cirtometria), função pulmonar (ventilometria), grau de dispneia (escala numérica) e nível de fadiga (escala visual analógica). RESULTADOS: Houve maior prevalência de pacientes classificados como CHILD B e o escore MELD médio foi de 14,73±5,75. A comparação dos parâmetros pré e pós paracentese evidenciou após a paracentese: aumento do padrão respiratório predominantemente abdominal, melhora das variáveis ventilatórias, aumento das diferenças obtidas na cirtometria axilar e abdominal, redução do nível de dispneia e fadiga, redução da pressão arterial e aumento da saturação periférica de oxigênio. Correlações positivas encontradas: cirtometria xifoide com axilar, grau de dispneia com nível de fadiga, volume corrente com volume minuto, CHILD "C" com maior escore MELD, volume drenado na paracentese com maior escore MELD e com CHILD "C". Também observamos uma correlação negativa entre volume corrente e a frequência respiratória. CONCLUSÃO: Uma vez que a drenagem da ascite em pacientes com cirrose hepática melhora os volumes pulmonares e a expansão torácica, além de reduzir sintomas como fadiga e dispneia, podemos concluir que a ascite tem um impacto respiratório e sintomatológico negativo nesses pacientes.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Ascite/complicações , Dispneia/etiologia , Fadiga/etiologia , Cirrose Hepática/complicações , Ascite/fisiopatologia , Ascite/terapia , Estudos Transversais , Dispneia/fisiopatologia , Fadiga/fisiopatologiaRESUMO
Introdução: A ascite é definida como um acúmulo de líquido na cavidade peritoneal e, em 75% dos casos, é causada por cirrose e hipertensão da veia porta de várias etiologias. Seu tratamento inclui restrição de fluidos, diurese e paracentese de grande volume. A paracentese de alívio é o procedimento de remoção de fluido ascítico da cavidade peritoneal com a finalidade de reduzir a pressão intra-abdominal e aliviar sintomas associados como dispneia, dor e desconforto abdominal. É uma técnica simples e segura que pode ser realizada em ambiente hospitalar e ambulatorial. A expansão dos Serviços de Atenção Domiciliar (SAD) no país oportunizou a realização de procedimentos de maior complexidade no domicílio podendo contribuir com o bem-estar de pacientes em cuidado paliativo domiciliar. Objetivo: Descrever o perfil de pacientes submetidos à paracentese de alívio em um SAD. Métodos: Estudo transversal, incluindo pacientes consecutivos que realizaram paracentese de alívio no domicílio entre os anos 2009 e 2017. Os dados foram coletados em prontuário. Para a análise descritiva dos dados estatísticos utilizou-se o Software Statistical Package for the Social Sciences v. 18.0 (SPSS). Resultados: A amostra foi composta por 15 pacientes, apresentando uma média do Índice de Comorbidade de Charlson de 8,1 (3-15). As neoplasias foram as principais causas de ascite nos pacientes acompanhados (80,2%). No período do estudo foram realizadas 48 paracenteses de alívio. Seis pacientes apresentaram sintomatologia clínica com necessidade de visita domiciliar (VD) não programada. Em relação às complicações do procedimento de paracentese, um paciente apresentou sangramento no local da punção. Todas as situações acima foram manejadas no domicílio. Em relação aos desfechos do atendimento no SAD, 53% dos pacientes necessitaram de reinternação hospitalar por piora clínica. Conclusões: A paracentese de alívio no domicílio mostra-se como uma prática segura, reduzindo idas desnecessárias a serviços de urgência/emergência e com bons índices de satisfação relatados pelos pacientes, desde que os profissionais sejam devidamente capacitados para realização do procedimento, com rotina e técnica instituída pelo SAD.
Introduction: Ascites can be defined as an accumulation of fluid in the peritoneal cavity and, in 75% of cases, is caused by cirrhosis and portal vein hypertension of different etiologies. Its treatment includes fluid restriction, diuresis and paracentesis. Relief paracentesis is a procedure that removes ascites fluid from peritoneal cavity, reduces intra-abdominal pressure and alleviate some symptoms such as dyspnea, pain, and abdominal discomfort. It is a simple and safe technique that can be performed in a hospital or outpatient setting. The expansion of home care services in our country has enabled the completion of more complex procedures at home and may contribute to the welfare of outpatients in palliative care. Objective: Describe the profile of outpatients undergoing relief paracentesis. Methods: Cross-sectional study, including consecutive patients of a public home care service who underwent home relief paracentesis between 2009 and 2017. Data were collected from medical records and the Software Statistical Package for the Social Sciences v. 18.0 (SPSS) was used for data analysis. Results: Sample consisted of 15 out patients. We observed an average of 8.1 (3-15) in Charlson Comorbidity Index and neoplasms were the main cause of ascites (80.2%). 48 relief paracenteses were performed during the period and six patients presented clinical symptomatology requiring unplanned home visit. Concerning complications of paracentesis procedure, only one patient had bleeding at the puncture site. All above situations were handled at home. Regarding outcomes of care, 53% of patients required hospital readmission because of clinical worsening. Conclusions: Home relief paracentesis is a safe practice and can reduce unnecessary procedures at an emergency room. It is important that professionals are properly trained to perform the procedure with routine and technique established by a home care service.
Introducción: La ascitis se define como una acumulación de líquido en la cavidad peritoneal y en el 75% de los casos es causada por cirrosis e hipertensión venosa portal de diversas etiologías. Su tratamiento incluye restricción de líquidos, diuresis y paracentesis de gran volumen. La paracentesis evacuadora es el procedimiento para eliminar el líquido ascítico de la cavidad peritoneal para reducir la presión intraabdominal y aliviar los síntomas asociados como disnea, dolor y molestias abdominales. Es una técnica simple y segura que se puede realizar en un hospital y en ambulatorio. La expansión de los Servicios de Atención Domiciliaria (SAD) en el país ha permitido completar procedimientos más complejos en el domicilio y puede contribuir al bienestar de los pacientes en cuidados paliativos domiciliarios. Objetivos: Describir el perfil de pacientes sometidos a paracentesis evacuadora en un SAD. Métodos: Estudio transversal, con pacientes consecutivos que se sometieron a paracentesis evacuadora en el domicilio entre 2009 y 2017. Los datos se obtuvieron de los registros médicos. Para el análisis descriptivo de los datos estadísticos utilizamos el Software Statistical Package for the Social Sciences v. 18.0 (SPSS). Resultados: La muestra consistió en 15 pacientes, con un índice de comorbilidad de Charlson promedio de 8,1 (3-15). Las neoplasias fueron las principales causas de ascitis en los pacientes seguidos (80,2%). Durante el período de estudio, se realizaron 48 paracentesis evacuadoras. Seis paracentesis presentaron sintomatología clínica que requería una visita domiciliaria (VD) no planificada. Con respecto a las complicaciones del procedimiento de paracentesis, un paciente tuvo sangrado en el sitio de punción. Todo lo anterior se manejó en el domicilio. En cuanto a los resultados de la atención en el SAD, el 53% de los pacientes requirieron reingreso hospitalario por empeoramiento clínico. Conclusiones: La paracentesis evacuadora en el domicilio es una práctica segura que reduce los viajes innecesarios a los servicios de urgencia/emergencia y con una alta satisfacción del paciente, siempre que los profesionales estén debidamente capacitados para realizar el procedimiento, con la rutina y la técnica establecidas por el SAD.