Management of Acute Iliofemoral Deep Venous Thrombosis in Inflammatory Bowel Disease - Transitioning From Conservative Management to Early Intervention.

Deep vein thrombosis (DVT) is a frequent complication in patients suffering from inflammatory bowel disease (IBD), especially in those with frequent relapses of the disease or extensive inflammatory lesions. The aetiology for the increased risk is multifactorial. Current evidence on management of acute iliofemoral DVT in IBD patients is scarce. This case series highlights two cases of active IBD, who developed acute iliofemoral DVTs and were treated with catheter-directed thrombolysis (CDT). This report demonstrates that CDT is effective in clearing the clot burden and producing significant symptomatic improvement in the absence of major complications. An individualised approach must be taken for the management of IBD patients with acute iliofemoral DVT.

The Use of Bovine Pericardial Patches in Vascular Surgery: Where do we Draw the Line in Obtaining Informed Consent?

For a patient undergoing a carotid endarterectomy, induction with propofol, administration of heparin at the time of vessel clamping, use of a bovine pericardial patch for angioplasty, covering the wound with a hydrocolloid dressing and post-operative aspirin administration exposes the patient to animal products at every stage, from the moment they walk through the door. A number of articles have advocated obtaining informed consent when using animal products in healthcare but where should the line be drawn? METHODS: A narrative review of the literature, specifically focussing on secular and religious beliefs about the use of animal products in healthcare. Application of ethical principles and GMC guidance to formulatea discussion with regards to the use of bovine pericardium in vascular surgery. Advanced literature search carried out using Pubmed and Google Scholar databases comparing patch material used forcarotid endarterectomy. RESULTS: Disclosing the use of animal derived constituents in surgery is warranted under Beauchamp and Childress' four principals and highlighted in GMC guidance. Obtaining consent for the use of animalderived constituents at the time of surgery is something that should become a fundamental component of the written consent process and alternatives should be sought where available and practicable. CONCLUSION: This review highlights the evidence available and discusses our current standpoint from both a legal and ethical aspect.

Using an original triage and on call management tool aids identification and assessment of the acutely unwell surgical patient.

Until now, there have been no published surgical triage tools. We have developed the first such tool with a tiered escalation policy, aiming to improve identification and management of critically unwell patients. The existing sheet which is used to track new referrals and admissions to the surgical assessment unit was reviewed. The sheet was updated and a traffic light triage tool generated using National Early Warning Scores (NEWS), sepsis criteria and user discretion. A tiered escalation policy to guide urgency of assessment was introduced and education sessions for all staff undertaken, to ensure understanding and compliance. Through multiple 'plan-do-study-act' cycles, the new system and its efficiency have been analysed. Prior to intervention, documentation of NEWS did not occur and only 13% of admission observations were communicated to the surgical team. Following multiple cycles and interventions, 93% of patients were fully triaged, and 80% of 'red' and 'amber' patients' observations were communicated to the surgical team. The average time for a registrar to review a 'red' patient was 37 min and 79% of 'green' patients were reviewed within an hour of their presentation. Rapid identification of the unwell patient is crucial. Here we publish the first triage tool that enables early assessment of septic and otherwise potentially unwell surgical patients.