SHM issues position statements on ultrasound and abdominal paracentesis

One statement from the Society of Hospital Medicine (SHM) reviewed the use of point-of-care ultrasound, while the other offered 12 recommendations on the use of ultrasound guidance for adult abdominal paracentesis.


The Society of Hospital Medicine (SHM) recently released two new position statements on the use of ultrasound by hospitalists.

The society's statement on point-of-care ultrasound (POCUS) is intended to provide guidance both for the hospitalists who use POCUS and the administrators who oversee its use. The statement discusses POCUS's current applications in hospital medicine, as well as related training, assessments (including certification and credentialing), and program management (including archiving, documentation, and quality assurance). The statement was published online by the Journal of Hospital Medicine on Jan. 2.

The other position statement, also published online by the Journal of Hospital Medicine on Jan. 2, offers recommendations on the use of ultrasound guidance for adult abdominal paracentesis.

SHM recommends that ultrasound guidance should be used for paracentesis to reduce the risk of serious complications, the most common being bleeding, as well as to avoid attempting paracentesis in patients with an insufficient volume of intraperitoneal free fluid to drain. In addition, SHM recommends that ultrasound guidance should be used with paracentesis to improve the success rates of the overall procedure and that ultrasound should be used to assess the volume and location of intraperitoneal free fluid to guide clinical decision making of where paracentesis can be safely performed.

Ultrasound should be used to identify a needle insertion site based on size of the fluid collection, thickness of the abdominal wall, and proximity to abdominal organs, and the needle insertion site should be evaluated using color flow Doppler ultrasound to identify and avoid abdominal wall blood vessels along the anticipated needle trajectory, SHM said. SHM also recommends that a needle insertion site should be evaluated in multiple planes to ensure clearance from underlying abdominal organs and detect any abdominal wall blood vessels along the anticipated needle trajectory; that a needle insertion site should be marked with ultrasound immediately before performing the procedure; and that the patient should remain in the same position between marking the site and performing the procedure.

Consideration of real-time ultrasound guidance for paracentesis is recommended when the fluid collection is small or difficult to access, SHM said. SHM recommends that dedicated training sessions should be used to teach novices how to perform ultrasound-guided paracentesis and that simulation-based practice should be used, when available, to facilitate acquisition of the required knowledge and skills to perform ultrasound-guided paracentesis. Finally, SHM recommends that competence in performing ultrasound-guided paracentesis should be demonstrated prior to independently performing the procedure on patients.