P118 Nurse-led paracentesis services – Inconsistencies in practice across the UK

<h3>Introduction</h3> Patients with advanced liver cirrhosis and refractory ascites are dependent on regular therapeutic paracentesis and often experience frequent hospital admissions leading to poor quality of life and increased healthcare costs.¹ Nurse led day-case services have been found to lower costs, reduce inpatient mortality and reduce pressures on acute medical services.¹Patients with ascites who undergo in-hospital paracentesis have a higher mortality rate than those who do not (9% vs 6%), with blind procedures conferring a statistically significant higher risk of complications than those which are US guided.² This survey aimed to understand current practice amongst nurse-led paracentesis services and identify the role for standardised training in the UK. <h3>Methods</h3> An electronic survey was distributed to 43 hepatology nurses from 32 hospital trusts across England and Scotland. The survey consisted of nine questions, encompassing the number of paracentesis procedures performed each month, receival of formal training, routine use and training with ultrasound machines, and views on formal competency documents. Qualitative feedback was also obtained via a comments section. <h3>Results</h3> 52% of the 32 trusts surveyed have a hepatology nurse led paracentesis service. Of the nurses practicing paracentesis, 79% had received formal training with majority of training provided by medical consultants. 25% do not routinely use ultrasound, and only 12% received formal ultrasound training. 95% agreed that training in paracentesis should be formalised with a competency document. <h3>Discussion</h3> With the growing burden of liver disease in the UK, there is increased demand for nurse-led paracentesis services. This survey reveals that training and practice of nurse-led paracentesis varies widely across the country. The gold standard of ultrasound guided paracentesis is not routinely practiced by a significant proportion of nurses, with several citing a lack of formal training as a barrier. The vast majority share enthusiasm for the development of a formal competency document, to reduce risk of exposure for practitioners. Future efforts should also focus on standardising training, for instance with the implementation of DOPS (direct observations of procedural skills) forms, to improve training quality, operator confidence and patient safety. <h3>References</h3> Hudson B, Round J, Georgeson B, Pring A, Forbes K, McCune CA, Verne J. Cirrhosis with ascites in the last year of life: a nationwide analysis of factors shaping costs, health-care use, and place of death in England. <i>Lancet Gastroenterol Hepatol</i>. 2018 Feb;<b>3</b>(2):95–103. doi: 10.1016/S2468-1253(17)30362-X. Epub 2017 Nov 15. Erratum in: Lancet Gastroenterol Hepatol. 2019 Feb;<b>4</b>(2):e1. PMID: 29150405. Cho J,<i> et al</i>. Recommendations on the use of ultrasound guidance for adult abdominal paracentesis: a position statement of the society of hospital medicine. <i>Journal of Hospital Medicine</i>. 2019;<b>14</b>(1). doi:10.12788/jhm.3095.