Implementing a nurse-led paracentesis service to improve patient care and experience in a day case unit

For many patients suffering from liver disease with ascites, symptomatic management of tense ascites (paracentesis) is a key element of their palliative care. A complete service review of a day case unit was conducted to identify areas for improvement in its paracentesis service. The evaluation used a structured questionnaire survey of patients and nurses, and semi-structured interviews with senior hepatology doctors. All important stakeholders were involved at various stages. It was deemed appropriate that a competence nurse training package be devised to enable nurses to perform paracentesis, and this was approved by the relevant hospital committees. Within 12 months of the service implementation, nurses had performed 385 procedures. The change has improved patient care, and waiting time has been reduced from an average of 2 hours to 17 minutes. This article will explore the background to the need for a nurse-led paracentesis service, and discuss the steps taken to implement it.