Ascites

What is an Ascites

Ascites is a collection of too much fluid in the abdomen. Ascites can range from mild to severe. If ascites is not treated, it can get worse.

What are the causes?

This condition may be caused by:

• A liver condition called cirrhosis. This is the most common cause of ascites.
• Long-term (chronic) or alcoholic hepatitis.
• Infection or inflammation in the abdomen.
• Cancer in the abdomen.
• Heart failure.
• Kidney disease.
• Inflammation of the pancreas.
• Clots in the veins of the liver.

What are the signs or symptoms?

Symptoms of this condition include:

• A feeling of fullness in the abdomen. This is common.
• An increase in the size of the abdomen or waist.
• Swelling in the legs.
• Swelling of the scrotum (in men).
• Difficulty breathing.
• Pain in the abdomen.
• Sudden weight gain.

If the condition is mild, you may not have symptoms.

How is this diagnosed?

This condition is diagnosed based on your medical history and a physical exam. Your health care provider may order imaging tests, such as an ultrasound or CT scan of your abdomen.

How is this treated?

Treatment for this condition depends on the cause of the ascites. It may include:

• Taking a pill to make you urinate. This is called a water pill (diuretic pill).
• Strictly reducing your salt (sodium) intake. Salt can cause extra fluid to be kept (retained) in the body, and this makes ascites worse.
• Having a procedure to remove fluid from your abdomen (paracentesis).
• Having a procedure that connects two of the major veins within your liver and relieves pressure on your liver. This is called a TIPS procedure (transjugular intrahepatic portosystemic shunt procedure).
• Placement of a drainage catheter (peritoneovenous shunt) to manage the extra fluid in the abdomen.

Ascites may go away or improve when the condition that caused it is treated.

Follow these instructions at home:

• Keep track of your weight. To do this, weigh yourself at the same time every day and write down your weight.
• Keep track of how much you drink and any changes in how much or how often you urinate.
• Follow any instructions that your health care provider gives you about how much to drink.
• Try not to eat salty (high-sodium) foods.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.
• Report any changes in your health to your health care provider, especially if you develop new symptoms or your symptoms get worse.

Contact a health care provider if:

• You gain more than 3 lb (1.36 kg) in 3 days.
• Your waist size increases.
• You have new swelling in your legs.
• The swelling in your legs gets worse.

Get help right away if:

• You have a fever.
• You are confused.
• You have new or worsening breathing trouble.
• You have new or worsening pain in your abdomen.
• You have new or worsening swelling in the scrotum (in men).

Summary

• Ascites is a collection of too much fluid in the abdomen.
• Ascites may be caused by various conditions, such as cirrhosis, hepatitis, cancer, or congestive heart failure.
• Symptoms may include swelling of the abdomen and other areas due to extra fluid in the body.
• Treatments may involve dietary changes, medicines, or procedures.

Ascites Drainage Catheter Placement

Ascites drainage catheter placement is a procedure to place a thin, flexible tube (catheter) in your abdomen to help drain excess fluid. Draining excess fluid from the abdomen can help to prevent pain and other problems from developing.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to nerves, tissues, or other structures.
• A small puncture (perforation) in your bowel.
• Leaking of fluids.
• Kidney problems.
• Liver problems.

What happens before the procedure?

• You may have a physical exam or testing.
• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do not take these medicines unless your health care provider tells you to take them.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
• Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Plan to have someone take you home from the hospital or clinic.
• Arrange to have someone help you with the drainage catheter at home in case you cannot do it yourself. Your health care provider can help you arrange for a home health service if needed.

What happens during the procedure?

• You will be asked to lie down on an X-ray table.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic).
• Machines will be used to monitor your blood pressure, heart rate, breathing rate, and blood oxygen level during the procedure.
• The skin in the insertion area will be cleaned with a germ-killing (antiseptic) solution.
• Sterile towels or drapes will be used to cover your abdominal area.
• A small incision will be made in your abdomen.
• The ascites drainage catheter will be inserted into your abdomen. An ultrasound will likely be used to help guide the placement.
• An X-ray may be taken to make sure that the catheter is in the right place.
• Stitches (sutures) will be used to partially close the incision and keep the catheter in place.
• A bandage (dressing) may be placed around the catheter at the insertion site.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• A health care provider may use the ascites drainage catheter to drain fluid from your abdomen.
• Do notdrive for 24 hours if you were given a sedative during your procedure.

Summary

• Ascites drainage catheter placement is a procedure to place a thin, flexible tube (catheter) in your abdomen to help drain excess fluid.
• Before the procedure, ask your health care provider about changing or stopping your regular medicines.
• The procedure is generally safe and well-tolerated.
• Carefully follow your health care provider’s instructions when you get home.

Ascites Drainage Catheter Placement, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain, soreness, and bruising near the area where the catheter was placed.
• Drowsiness or trouble remembering things, if you were given a medicine to help you relax during the procedure (sedative). This may last for several hours while the medicine wears off.

Follow these instructions at home:

General instructions

• Rest as told by your health care provider.
• Avoid sitting for a long time without moving. Get up to take short walks every 1–2 hours. This is important to improve blood flow and breathing. Ask for help if you feel weak or unsteady.
• Weigh yourself every day. A change in weight may mean that too much fluid is building up in your body. Ask how much change in your weight would give you a reason to call or visit your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you are asked to drain fluid at home, follow instructions from your health care provider about how to do that.
• Follow any dietary instructions from your health care provider. You may need to:
  • Limit foods and liquids that increase or decrease how much fluid your body holds onto (retains).
  • Limit how much salt (sodium) you eat.
  • Eat a high-protein diet. This includes foods like meat, fish, eggs, and beans.
  • Avoid alcohol.

Keep all follow-up visits as told by your health care provider. This is important.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.

Check your incision area every day for signs of infection. Check for:

• Redness, swelling, or more pain.
• Fluid or blood.
• Warmth.
• Pus or a bad smell.

Contact a health care provider if:

• You have redness, swelling, or pain around the incision area where the catheter was inserted.
• You have fluid or blood coming from the insertion site.
• Your insertion site feels warm to the touch.
• You have pus or a bad smell coming from the insertion site.
• You have trouble draining fluid.
• You have trouble caring for your catheter.
• You have pain, bloating, or cramping in your abdomen.

Get help right away if:

• You develop a fever or chills.
• You have increasing redness or increasing pain around the insertion site.
• The fluid that drains out of the catheter turns cloudy or has a bad smell.
• You have abdominal pain or cramping that gets worse or does not go away.

Summary

• You may have pain, soreness, and bruising near the area where the catheter was placed.
• Weigh yourself every day. A change in weight may mean that too much fluid is building up in your body.
• Follow instructions from your health care provider about how to care for the incision area.

Ascites Drainage Catheter Home Guide

An ascites drainage catheter is a thin, flexible tube that helps to drain excess fluid that has collected in the abdomen. Draining the fluid can help to prevent pain and other problems from developing.

There are several kinds of ascites drainage systems. Your health care provider will teach you how to use your system. He or she will also give you directions about how much fluid to drain and how often to drain it. Follow these general guidelines as well as the instructions that you receive about your specific drainage system. Call your health care provider if you have any questions or concerns.

How do I use the catheter to drain fluid?

1. Clean any surface that you will be using.
2. Wash your hands with soap and warm water. If your hands are not visibly dirty, you can use an alcohol-based skin cleaner instead.
3. Put on a mask. Make sure that it covers your nose and your mouth.
4. Within reach on the surfaces that you have cleaned, place all of the supplies that you will need.
5. Clean the safety valve with an alcohol wipe.
6. Attach the adapter or access tip to the safety valve on your catheter. To do this, you may need to remove a protective cap on the safety valve.
7. Release the clamps on your drainage container.
8. Allow the fluid to drain into the container.
9. Close the clamps and release the catheter from the drainage container.
10. Write down the amount of fluid that was drained, if your health care provider has directed you to do that.
11. Follow instructions from your health care provider about storing and transporting the fluid if you are directed to bring the fluid to your health care provider’s office. If you are told to dispose of the fluid, pour it down the toilet or do as directed by your health care provider.
12. With an alcohol-based or bleach-based cleaner, clean the surfaces where any fluid was spilled.

What should I do after I drain the fluid?

1. Wipe the end of your catheter with an antiseptic solution, such as rubbing alcohol.
2. Put the protective cap back onto the safety valve.
3. Place gauze bandages (dressings) around the catheter site as directed by your health care provider.
4. Secure the catheter to your body with gauze and dressings as directed by your health care provider.

Contact a health care provider if:

• You have skin irritation, redness, or pain where the catheter was inserted (insertion site).
• You have trouble draining fluid.
• You have trouble caring for your catheter.
• You have abdominal pain, bloating, or cramping.

Get help right away if:

• You develop a fever or chills.
• You have increasing redness or increasing pain around the insertion site.
• You have blood or pus coming from the insertion site.
• Fluid that drains out of the catheter becomes cloudy or has a bad smell.
• You have abdominal pain or cramping that worsens or does not go away.