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Palliative_Management_of_Malignant_Ascites_Guidance.pdf

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This is an official Northern Trust policy and should not be edited in any way Palliative Management of Malignant Ascites Guidance Reference Number: NHSCT/11/396 Target audience: This Trust-wide policy is directed to medical and nursing staff working with adult patients in the acute hospital setting. Sources of advice in relation to this document: Dr Jayne McAuley, Consultant Palliative Medicine Dr Olivia Dornan, Consultant A & E Replaces (if appropriate): Pr
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    This is an official Northern Trust policy and should not be edited in any way   Palliative Management of Malignant Ascites Guidance Reference Number: NHSCT/11/396 Target audience: This Trust-wide policy is directed to medical and nursing staff working with adult patients in the acute hospital setting.  Sources of advice in relation to this document: Dr Jayne McAuley, Consultant Palliative Medicine Dr Olivia Dornan, Consultant A & E  Replaces (if appropriate): Previous Guidance for the Palliative Management of Malignant Ascites (2007)  Type of Document: Trust Wide Approved by: Policy, Standards and Guidelines Committee Date Approved: 15 December 2010 Date Issued by Policy Unit: 12 April 2011  NHSCT Mission Statement To provide for all, the quality of service we expect for our families, and ourselves.    Palliative Management of Malignant Ascites Guidance December 2010    Contents  Introduction 1 Purpose of the Guidance 1 Target Audience 1 Responsibilities 1 Equality, Human Rights and DDA 1 Alternative formats 2 Source of advice in relation to this document 2 Policy Statement 2 Management Plan 2 Checklist for Abdominal Paracentesis Consent 5 References 6    1   Palliative Management of Malignant Ascites Guidance Introduction Ascites is the accumulation of protein rich fluid in the peritoneal cavity and can be classed as an exudate or transudate depending on the serum ascites albumin gradient. It can occur in conditions such as cirrhosis of the liver, heart failure, tuberculosis but over 90% is secondary to malignancy. The commonest cancers to cause ascites are ovarian, breast and gastrointestinal. Peritoneal involvement by the cancer causes an exudate to form with a high albumin content and low gradient (<11g/L), while less commonly a transudate can form secondary to cirrhosis or large liver metastases, with a low albumin content and high gradient (>11g/L).  Purpose of the Guidance Malignant ascites can give rise to distressing symptoms such as nausea, vomiting, abdominal distension, pain and breathlessness and carries a poor prognosis. Treatment should therefore be minimally invasive with minimisation of the risk of complications and aimed at the relief of symptoms. This guidance has been developed to support current best practice in the palliation of malignant ascites at the end of life. Target Audience This Trust-wide policy is directed to medical and nursing staff working with adult patients in the acute hospital setting. Responsibilities Directors Responsibility is delegated to individual Directors who have responsibility to ensure that this guidance has been disseminated to the clinical staff working within their area of responsibility. Clinical staff working in hospital and community environment It is the responsibility of clinical staff working with adult patients in the acute hospital setting to be aware of the guidance and to implement it when appropriate. Equality, Human Rights and DDA The guidance is purely clinical in nature and will have no bearing in terms of its likely impact on equality of opportunity or good relations for people within the equality and good relations categories.
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