Potential long-term abdominal drain (LTAD)-related complications when used in end-stage liver disease
| Complication | Recommended management | Incidence observed in the REDUCe trial (LTAD vs LVP)5 |
| Leakage | Usually self-limiting, if persists may need an extra suture. Continue ascites drainage via LTAD | Leakage/cellulitis 41% vs 11% |
| Cellulitis | Usually results due to leakage and is again self-limiting. If persist may need a short course of antibiotics. Very rarely LTAD needs to be removed and can be resited | |
| Suspected peritonitis | Do a diagnostic tap for cell count and culture from peritoneum as well as taking sample from LTAD. Treat as per usual peritonitis guidelines. Decision to remove LTAD must be made on a case by case basis after discussion with patient/caregiver Routine sampling of ascitic fluid from LTAD and or routine blood tests in asymptomatic patients is not recommended. | 6% vs 11% |
| Elevation in serum creatinine | Manage as clinically indicated | Baseline and week 12 serum creatinine (μmol/L) (median, IQR) LTAD vs LVP groups: 109 (79–141) vs 113.5 (89–134) and 104.5 (81–115.5) vs127(63–158), respectively. |
| LTAD blockage | Admit to hospital and discuss need for replacement | 0% |
| LTAD displacement | Admit to hospital if necessary and discuss need for replacement | 6% |
| Bleeding | Usually self-limiting | 0% vs 5% |
| Unable to manage ascites symptoms despite draining 1–2 L three times a week from LTAD | Will need LVP in hospital—drain ascitic fluid via LTAD using adaptor with human albumin solution as per standard LVP protocols | 13% |
LVP, large volume paracentesis.