Evaluation of a Registered Nurse-Led Outpatient Paracentesis Service for Decompensated Cirrhosis: A Retrospective Review.

backgroundAscites is a common and debilitating complication of decompensated cirrhosis that frequently requires therapeutic paracentesis (TP) for symptom relief. Limited outpatient procedural capacity may contribute to avoidable hospital readmissions. The use of registered nurses (RNs) to perform TP remains uncommon, with few models described internationally.

objectiveTo evaluate the safety of an RN-led outpatient TP model and describe the potential geographic reach of patients accessing care at a Canadian tertiary liver clinic.

methodsA retrospective chart review was conducted of all outpatient TP procedures performed at Toronto General Hospital between 6 June 2022 and 28 February 2023. Procedures were performed either in the Medical Day Unit (MDU; performed by physicians/nurse practitioners) or in the Liver Clinic (LC) procedure room by trained RNs. The primary outcome was the occurrence of predefined procedure-related adverse events. Adverse events were identified through review of clinical documentation, including emergency department visits within the institutional health network and patient-reported events documented in the electronic medical record. A secondary analysis examined geographic patterns of access using patient residential postal codes.

resultsA total of 124 patients underwent 580 TP procedures, of which 55.2% were performed by RNs. Alcohol-associated liver disease and metabolic dysfunction-associated steatotic liver disease were the most common underlying etiologies. No procedure-related complications were identified (0%; 95% CI: 0-0.52%). Most patients resided within the Greater Toronto Area; however, some travelled up to 360 km, often bypassing closer hospitals, to access outpatient services.

conclusionsAn RN-led outpatient TP model demonstrated reassuring safety signals and contributed to expanded procedural capacity within an ambulatory liver programme. These findings support the feasibility of nurse-led procedural models as a strategy to improve access to care for patients with decompensated cirrhosis. Further evaluation is needed to assess the impact of this approach on healthcare utilisation and patient-reported outcomes.