Long-term intraperitoneal catheters: A novel ambulatory care intervention for the management of refractory cirrhotic ascites during COVID-19.

Background and Aim: The coronavirus disease 2019 (COVID-19) pandemic has created challenges in how health care systems provide care for patients with refractory cirrhotic ascites. We aimed to investigate the safety and efficacy of a novel ambulatory care program developed with Hospital in the Home (HITH) to allow frequent low-volume ascitic drainage through a long-term, tunneled, intraperitoneal catheter (IPC; Rocket Medical) in patients with advanced cirrhosis. Method(s): We conducted a prospective cohort study at a Victorian tertiary health care service from April to July 2020. Adult patients with refractory cirrhotic ascites requiring large-volume abdominal paracentesis twice in the past 8 weeks were recruited. We excluded patients otherwise eligible for transjugular intrahepatic portosystemic shunt (TIPS) insertion or liver transplantation and those with Child-Pugh C disease, prior spontaneous bacterial peritonitis, active infection, loculated ascites, or hepatic hydrothorax. All IPCs were inserted by an interventional radiologist and managed for 12 weeks by HITH in lieu of recurrent hospital admission for large-volume paracentesis. The drainage schedule was individualized, with 1-6 L drained by HITH nurses over 1-3 sessions per week, without human albumin infusions. All patients received antibiotic prophylaxis (norfloxacin 400 mg daily or trimethoprim-sulfamethoxazole 160-800 mg daily). The primary endpoint was safety (death related to IPC, rates of bleeding, peritonitis, and cellulitis), with secondary endpoints including symptom burden, IPC attrition rates, and quality of life (EuroQol 5 dimensions). Result(s): Five patients (median age, 60 years; IQR, 53-74; four male) underwent insertion of an IPC. All had Child-Pugh B disease, with a median Model for End-Stage Liver Disease score of 11 (IQR, 9-13). The etiology of liver disease was alcohol (n = 4) and hepatitis C (n = 1). All patients were ineligible for TIPS due to prior hepatic encephalopathy and ineligi