The National Institute for Health and Care Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Subcutaneous implantation of a battery operated catheter drainage system for management of refractory and recurrent ascites due to liver cirrhosis in February 2014.

June 2018: NICE is updating this guidance (see the guidance in development page for information). The NHS should continue to follow the recommendations in this guidance until the update is complete.


Ascites is a common complication of cirrhosis of the liver and metastatic cancer in the abdomen. The build-up of fluid causes the abdomen to swell and may lead to discomfort, difficulty breathing, fatigue, nausea and poor appetite.

Medical treatment with sodium restriction and diuretics is used in many patients. For patients with treatment-resistant or recurrent ascites, treatment options include large-volume paracentesis, albumin infusion and insertion of transjugular intrahepatic portosystemic shunts. These procedures may be used to support a patient before liver transplantation.

Coding recommendations

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)