1 Recommendations

Guidance

1.1 Current evidence on the safety of subcutaneous automated low-flow pump implantation for refractory ascites shows there are serious but well-recognised safety concerns, including device failure and acute kidney injury. Evidence on efficacy is limited in quantity. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

1.2 Clinicians wishing to do subcutaneous automated low-flow pump implantation for refractory ascites should:

Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the procedure's safety and efficacy, as well as any uncertainties about these. Provide them with clear written information to support shared decision-making. In addition, the use of NICE's information for the public on subcutaneous automated low-flow pump implantation for refractory ascites is recommended.
Audit and review clinical outcomes of all patients having subcutaneous automated low-flow pump implantation for refractory ascites. NICE has identified relevant audit criteria and has developed NICE's interventional procedure outcomes audit tool (which is for use at local discretion).

1.3 All device failures should be reported to the Medicines and Healthcare products Regulatory Agency.

1.4 Patient selection should be done in specialist centres, by clinicians experienced in managing liver disease and in the various options available for managing ascites.

1.5 Further research should report details of patient selection, the frequency of pump-related complications, and the need for regular albumin infusions.