Abdominal paracentasis: provisional sample protocol for gynaecologic oncology patients, pilgrim hospital,united Lincolnshire hospitals NHS trust

Abstract

Aims and Objectives: The thesis or central idea about this protocol was to create a provisional or sample protocol which could be programmed to evolve and improve over time, through a systematic review process, say, every two years, in the department. Thus, its aim was to provide a harmonise surgical care approach to performing abdominal paracentesis through evidence-based initial sample protocol, which if later approved, would be used by all staff including trainees, involved in the management of gynaecological oncology patients, who needed abdominal paracentesis performed on them, for therapeutic and investigative reasons, and for symptomatic relief. Thus, the ultimate goal was the development of new, harmonized approach or model for surgical care, and for the training of the next generation of surgical specialists, with high standards of clinical practice to improved care outcomes, for this group of patients. Definitions: Abdominal paracentesis is a surgical procedure in which a specially designed needle is used to remove a sample of fluid or to drain an abnormal accumulation of intra-abdominal fluid. It is sometimes called or generally referred to as peritoneocentesis. In the latter, the peritoneal cavity is punctured with a specially designed needle to sample peritoneal fluid. This procedure is used to remove fluid from the peritoneal cavity, especially when this cannot be removed by the use of medication. In another way, it can be defined as a procedure which involves the surgical puncture of the abdominal cavity with a needle followed by a placement of a catheter line for the removal of excess peritoneal fluid. It is thus, a safe effective procedure used for therapeutic and diagnostic assessment, and evaluation of many intra-abdominal pathological problems. It often provides significant symptomatic relief which enables patients to engage and perform other recuperative activities. Historically, it has evolved as with other procedures and currently many specialists would perform ultrasound before attempting manual abdominal paracentesis. Others advocate ultrasound-guided abdominal paracentesis, as it appears to be comparatively less painful and less time-consuming; that is; the abdominal paracentesis can be performed at the same time that abdominal and pelvic ultrasound is performed to locate ascitic fluid and mark safe site(s) for its sampling or removal. Materials and methods: As this is an initial sample protocol, there was no specific methods or approaches used other than collation of approaches in gynaecology oncology literature. These were then analysed and synthesized to bring about what could be a more generally acceptable sample, or a “common or middle ground” acceptable template. These published works were also systematically referenced accordingly. The final provisional sample protocol must then be reviewed by relevant senior practitioners at multidisciplinary meetings, and make recommendation(s) to amendment or reviewed before the final draft sample would be adopted for use. Results: The below sample was produced and sent to be reviewed by the relevant senior practioners in the Gynaecology Oncology Team. Conclusion: As new scientific knowledge and technology emerge, the produced protocol (template) can be reviewed and updated. It is suggested that the approved protocol be reviewed and updated every two years, in line with the emergence of new evidence or scientific knowledge.