1 Recommendations

Guidance

1.1 Evidence on the safety of long-term tunnelled peritoneal drainage catheter insertion for refractory ascites in cirrhosis is limited but shows well-recognised complications. Evidence on the efficacy is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

1.2 Clinicians wanting to do long-term tunnelled peritoneal drainage catheter insertion for refractory ascites in cirrhosis should:

Inform the clinical governance leads in their healthcare organisation.
Give people (and their families and carers as appropriate) clear information to support shared decision making, including NICE's information for the public.
Ensure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.

1.3 Healthcare organisations should:

Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.
Regularly review data on outcomes and safety for this procedure.

1.4 Patient selection, continued community care support and follow up should be done by a multidisciplinary team experienced in managing the condition. The team should include a hepatologist, a specialist community nurse and specialist level palliative care.

1.5 NICE encourages further research into long-term tunnelled peritoneal drainage catheter insertion for refractory ascites in cirrhosis.