Table 2 Symptoms and management of long-term complications
Clinical symptom | Diagnosis/complication | Management |
|---|---|---|
Distended abdomen | Ascites accumulation (Device malfunction) | Paracentesis Referral to expert centre Determination of type of device malfunction Surgical re-intervention if indicated |
Elevated protein in urine | Ascites in urine (consequence of alfapump® action) | No reason for concern if no other signs of UTI are present |
Fever (≥ 2 days) | Infection · SBP · Device colonisation · UTI | Initiation of antibiotic treatment Referral to expert centre Diagnostic paracentesis for exclusion of SBP Identification of causative agent incl. antibiotic susceptibility profile in collaboration with local infection management Explant pump if no signs of improvement after initiation of antibiotic treatment |
Implant site redness, swelling, or pain | Cellulitis Ascites leakage into pump pocket | Initiate antibiotic treatment Revision of device (catheter dislocation?) Surgical re-intervention if indicated |
Increase of serum creatinine ≥ 0.3 mg/dl or 1.5–twofold above pre-implant levels | AKI | Treatment with albumin infusion with or without terlipressin according to guidelines and local standards (Temporary) reduction of TDV |
Urination problems | Dehydration AKI | Revision of fluid management (Temporary) reduction of TDV Treatment with antibiotics, terlipressin and albumin infusion according to guidelines and local standards |
Wound leakage | Wound dehiscence Catheter dislocation (ascites leakage into pump pocket) | Wound revision Surgical re-intervention if indicated |