Reported Variations in Abdominal Paracentesis Practices Across Australian Hospitals: A Cross-Sectional Survey

Objectives To evaluate the current practices, procedural techniques, and periprocedural management of large volume paracentesis (LVP) among medical practitioners in Australian hospitals, and to identify variations that may inform future standardisation of practice. Design Cross-sectional, web-based survey conducted in accordance with the CROSS (Consensus-Based Checklist for Reporting of Survey Studies) guidelines. Setting Public hospitals across Australia between April 2022 and October 2023. Participants Medical practitioners from a range of specialties and seniority levels who had performed at least one abdominal paracentesis. Participants were recruited via convenience, purposive, and chain-referral sampling methods at national meetings and through professional networks. Main Outcome Measures Primary outcomes included training requirements, procedural technique, and periprocedural management of LVP, specifically exploring haemostatic thresholds, ultrasound use, drain volume limits, albumin replacement, and timing of drain removal. Results Sixty-four practitioners completed the survey. Most were registrars (58%) and worked in gastroenterology (63%). Half (50%) reported the availability of a local paracentesis protocol. 93% indicated that formal accredited training was not required. Ultrasound was routinely used by 66% of respondents; 74% used it for site marking and 26% for real-time guidance. The median minimum acceptable platelet count was 50 × 10⁹/L (IQR 50–50), while the median maximum acceptable INR was 2.0 (IQR 1.6–3.0). No clear patterns were observed regarding timing of albumin replacement, although was most frequently commenced after 3 L was drained (42%), and typically replaced at 20 g for every 2 L of ascites drained. The mean maximum drainage volume was 10.5 L (SD 2.1). The mean maximum drain duration was 10.1 h (SD 10.3). Conclusions Among this survey cohort, the practice of LVP is highly heterogenous, with notable variation in training requirements, procedural technique especially regarding ultrasound use, timing of albumin replacement and drain removal. This highlight a need for standardised protocols to improve consistency, safety and quality of care for patent undergoing LVP.