This tool guides you through the Emergency Department portion of the Paracentesis Collaboration Pathway.
Clinical Best Practice: Hepatology recommends performing a diagnostic paracentesis before discharging any patient with new or large ascites from the ED, even if they are scheduled for a therapeutic LVP later.
ED Evaluation
A patient with ascites presents to the ED. The provider completes a workup including platelets and INR.
Pathway Candidacy
Is the patient expected to improve after LVP, with no evidence of complicating conditions (e.g., sepsis, SBP)?
Outcome: Not a Candidate
The patient is not a candidate for this pathway and requires alternative management.
Scheduling: Day of Week
Is it currently a weekday?
Weekday Scheduling: Time of Day
Is it currently between 6:30 AM and 4:00 PM?
ED Action: Weekday Daytime Plan
Follow these steps to arrange the procedure:
Step 1: Vocera the group "ED Paracentesis Referral" with the patient's information.
Step 2: Place an order for "US Paracentesis" under an "outpatient encounter". (See link in footer for detailed ordering guide.)
Step 3: After confirming timing with the team, discharge the patient with the instructions "ED Paracentesis Post Discharge Instructions" for their appointment.
Weekday Overnight: Disposition
For a stable patient needing a procedure the next morning, what is the plan?
ED Action: Weekday Overnight Plan
Follow these steps to arrange the procedure for 6:30am:
Step 1: Call the ultrasound sonographer at 4-1383 to place the patient on the schedule. Do NOT page the referral group overnight.
Contingency: If you cannot reach the sonographer, message Molly Miller and Emily Forrester in Impact.
Step 2: Place an order for "US Paracentesis". (See link in footer for detailed ordering guide.)
Step 3: Discharge the patient with instructions to return at 6:30am, or hold them in the ED if necessary.
Weekend Plan
What is the most appropriate option for this patient?
ED Action: Consult Procedure Service
This is the preferred option if available during the day on a weekend.
Step 1: Order a "Procedure Service Consult".
Step 2: Vocera the "Procedure Service" team to check if they can perform the paracentesis in the ED.
ED Action: Schedule for Monday Morning
For stable patients who can wait until Monday.
Step 1: Call the ultrasound sonographer at 4-1384 to schedule the patient for Monday at 6:30am.
Step 2: Place an order for "US Paracentesis". (See link in footer for detailed ordering guide.)
Step 3: Discharge the patient with clear instructions to return.
Action: Symptomatic Relief
The patient cannot wait for a scheduled procedure. Perform a medium volume paracentesis (~3L) for symptomatic relief.
Symptom Check
After the medium volume paracentesis, have symptoms improved enough for discharge with a scheduled follow-up?
ED Action: Hold for Procedure
The patient's symptoms have not sufficiently improved for discharge.
Action: Consider ED observation or admission to hold the patient for the next available procedure slot (e.g., Monday AM).
Order: Ensure an order for "US Paracentesis" is placed for the receiving service. (See link in footer for detailed ordering guide.)