Hello everyone! I have worked with hospice for over five years and I am a certified hospice and palliative nurse. The hospice I worked with did perform paracentesis because we considered this procedure a comfort measure for our patients. The procedure helps to relieve pressure to decrease pain and improve breathing, leading to less discomfort for patients. However, some hospices considered this an aggressive measure and do not perform any paracentesis. Actually 3 out of the 4 agencies in my area do not perform this procedure and this makes me frustrated at times. Patients with ESLD usually require paracentesis and as their disease progresses, the more often and frequent the tapping becomes. I would start out scheduling my patients to have one every month, then it usually led to twice a month and then every week. But, considering that the condition is terminal, the treatments usually begin to become futile and you will notice that a tap will begin to have less positive effects and fewer benefits because the fluids begins to come back almost immediately. So, often families have to decide if the paracentesis are worth it. With end stage liver disease, protein levels (albumin) is very low and you need this for the fluid to stay in the vascular space and with low levels, the fluids shifts and third spaces causing ascites. You also have to be careful, because pulling off too much fluid can cause hypovolemia and patients can develop shock, which causes even worse symptoms. When I worked with hospice, I would always schedule as many paracentesis as possible, but they become non-beneficial as the disease progresses. This is the point when you manage the symptoms that come along with the pain, shortness of breath, fluid overload and discomfort. This is where the goals of treatment really become more of a palliative approach. We used morphine, dilaudid, and fentanyl a lot for pain which also helps with breathing. Oxygen and a hospital bed to keep the head of the bed elevated work very well. Lasix and spironolactone are diuretics of choice. Breathing treatments can also be beneficial. Ativan and Vistaril/Hydroxyzine are also good for itching and anxiety associated with this disease process. They may make patients have a side effect of drowsiness in the beginning but this subsides as patients build a tolerance after a few doses. At times, we even had a tenckhoff catheter placed into the peritoneal cavity to drain fluid at home as needed, without having a tap performed. The whole point is to do what it takes to make the patient as comfortable as possible and give them the best quality of life possible in the short amount of time they have. I am 31 years old, but lost my mom to cancer and my aunt to end stage liver disease. It is very difficult to see a loved one go through a terminal illness and the dying process. I am very passionate about this subject and I am studying for my nurse practitioner and have even looked into being able to perform taps at bedside when I return to my hospice career. If you have any more questions, I would be glad to answer. I hope this information was helpful, thanks and my prayers are with you all!