Reducing the Environmental Footprint of Paracentesis

Introduction: Reducing the environmental footprint of gastroenterology practice was recently declared as a priority by the four major gastroenterology societies. There is a call and a need to reexamine all practices and propose ideas to decrease medical waste. We examined the practice of using pre-packaged kits for paracentesis at a single academic hospital in Texas, since we noticed that many of the items were discarded without being used. Methods: Two pre-packaged paracentesis kits were opened and examined. One kit was frequently used by internal medicine residents, the other was used by interventional radiologists. These kits were used for both diagnostic and therapeutic paracentesis. The items in each kit were separated into those that were frequently used and those that were discarded without use. Results: The kit primarily used by internal medicine residents (kit 1) was intended for both paracentesis and thoracentesis. Figure 1A displays all contents of kit 1; Figure 1B displays the items that were routinely discarded prior to therapeutic paracentesis. For therapeutic paracentesis, 17 of the 30 items in the kit were unused (57%). For diagnostic paracentesis, 21 (70%) were unused and discarded. Kit 2, shown in Figure 1C, was used by the interventional radiologists. It had fewer items disposed of prior to use (Figure 1D), with only 6 out of 20 items (30%) discarded for therapeutic paracentesis. Information about items discarded when performing diagnostic paracentesis was not available. Both kits required additional supplies to attach the abdominal catheter to wall suction for therapeutic paracentesis, culture bottles for specimen collection for diagnostic paracentesis, and various additional items depending on the preference of individual performing physicians. Conclusion: Prepackaged kits are often used at hospitals for convenience and are often made all encompassing, which promotes waste. Notably, the same kit is used for both diagnostic and therapeutic paracentesis, even though diagnostic paracentesis needs fewer supplies. Much of this waste is plastic, non-biodegradable and will stay in landfills for centuries. We propose that manufacturers should introduce kits with only essential supplies and hospitals should consider packaging their own paracentesis kits. Physicians should be educated about this waste and the carbon footprint of their actions.Figure 1.: A) Full contents of Kit; B) Items discarded from Kit 1 for a therapeutic paracentesis; C) Full contents of Kit 2; D) Items discarded from Kit 2 for a therapeutic paracentesis.