Authors (including presenting author) :
TANG V(1), CHENG M(2), T YU(2), F HUI(1), LUI N(1), LI WH(1), LEE SC(1), WONG E(1), LIU J(1), KOK YC(1), CHOW FK(2), YEUNG NY((3), LEUNG WM(3)
Affiliation :
(1)Virtual Ward, Kowloon Hospital, (2)Rehabilitation Department, Kowloon Hospital, (3)Oncology Department, Queen Elizabeth Hospital
Introduction :
Malignant ascites is an abnormal accumulation of peritoneal fluid in the peritoneal cavity due to cancer (Ammour & Prommer, 2010). It is the burden of end of life in advanced cancer patients that lead respiratory and gastrointestinal discomfort (Suvvari, 2021). These cancers may be ovarian cancer, intrahepatic and bile duct cancer, or peritoneal cancer. Removal of excess peritoneal fluid helps to control pain, nausea, anorexia (McNamara, 2000) and reduce intra-abdominal pressure, allowing patients to breathe smoothly. In the past, these patients needed to admit to hospital to receive the treatment for paracentesis. Through the collaboration among Oncology Department of QEH and Virtual Ward (a home care team for end-of-life patient) of Kowloon Hospital, the abdominal drainage has been carried out at home in the community.
Objectives :
Objective The regular sessions of the abdominal drainage procedure in day hospital become home based. Advantage -The procedures become home based. -As this group of patients are very frail, the transportation issue and its burden of their care-givers will be minimized. - Care-givers can voluntary participate in the caring procedure Patients can s pend more time and enjoy the precious moment with family at home. -It improves the quality of life that allow the patients feel more comfortable at home. - Risk of hospital acquired infection and additional infection control related to COVID could be avoided.
Methodology :
- Preparation work from Oncology Department and Virtual ward - Develop clinical guidelines and workflow, not more than 4,000 mL fluid to be drained out each time. - Virtual Ward nurses visit the Oncology Department for standardization of the procedure. - Cases selection: *Patients with recurrent malignant ascites on long-term peritoneal pigtail drain *Patients with frail condition and willing to have abdominal drainage at home *Hemodynamically stable *Patients do not need albumin infusion before or after abdominal drainage - Medical and care support by Oncology Day Ward and Virtual Ward
Result & Outcome :
1. Since 2020, a total of 65 home visits (14 in 2020 and 51 in 2021) with abdominal drainage procedure were done in home with nil complication. 2. Both the patients and the family appreciate the home drainage. 2. Improve the quality of life of terminal cancer patients. 3. Many resources involving the patients & health care providers can be saved by the home based procedure especially in the pandemic of COVID-19. 4. The skill can pass to other community team if needed. 5. The service model can roll out to other procedures.
