Bedside ultrasonography prior to abdominal paracentesis is associated with low complication and high success rate: Experience in a National Health Service District General Hospital in the United Kingdom from 2013 to 2019.

Aims/Background: To analyse data from a bedside ultrasound-assisted ascites procedure service in a National Health Service District General Hospital and compare them to results of studies in the medical literature. Methods: A retrospective review of audit data collected (January 2013 to December 2019) of the practice of paracentesis in a National Health Service District General hospital. All adult patients referred to the ascites assessment service were included. Bedside ultrasound detected location and volume of ascites, if present. Abdominal wall diameters were determined in order to select the appropriate needle length for procedures. Results and scan images were recorded on a pro-forma. Patients who underwent a procedure were followed up for 7 days, with complications documented. Results: Seven hundred and two scans were performed on 282 patients - 127 (45%) male and 155 (55%) female. In 127 (18%) patients, an intervention was avoided. Five hundred forty-five (78%) patients underwent a procedure: 82 (15%) were diagnostic aspirations and 463 (85%) were therapeutic (large volume) paracentesis. Most scans were performed between 08:00-17:00. Average time from patient assessment to diagnostic aspiration was 4 hours 21 minutes. Complications included three failed procedures (0.6%) and one iatrogenic peritonitis (0.2%), but no bowel perforation, no major haemorrhage or death. Conclusion: It is possible to introduce a bedside ultrasound-assisted ascites procedure service to a National Health Service District General Hospital with a high success and low complication rate.

Stability and in vitro efficacy of antibiotic-heparin lock solutions potentially useful for treatment of central venous catheter-related sepsis.

OBJECTIVES: Increasing numbers of patients for whom infection is a major risk are dependent on central venous catheters. Antibiotic-anticoagulant locks may have a role in preventing or treating catheter-related infections. The aim of this study was to determine the in vitro stability and efficacy of antibiotic-heparin lock solutions. METHODS: Candidate antibiotics (amikacin, ciprofloxacin, flucloxacillin, gentamicin, linezolid, teicoplanin) were investigated in vitro, either individually or in combination, in solution with heparin. The solutions were initially tested for visual precipitation. The efficacy of stable solutions and taurolidine was then tested in a catheter model bioassay system against microorganisms commonly encountered in catheter-related septicaemia. RESULTS: In general, lower concentrations of heparin (