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This paper describes a patient with an inoperable gastrointestinal stromal tumour with moderate volume malignant ascites. A large-volume paracentesis caused haemodynamic instability and a myocardial infarction. An indwelling right-sided peritoneal catheter was inserted following further ascites build-up. The patient experienced spontaneous acute rupture of tumour and subsequent loculated ascites. An additional second catheter was inserted to the left side of the abdomen following reaccumulation of ascites following liquefaction of cyst contents and successful one-off drainage on the left side of abdomen. This is the first case report of a patient with two indwelling catheters: we describe learning points pertaining to those as well as the rupture of gastrointestinal stromal tumours. Haemodynamic instability after paracentesis in malignant-related ascites has also not been described

Results 410 ultrasounds were performed, 3 (<1%) of these were in the patient's own home. All scans were performed by a Palliative Medicine Consultant or Clinical Fellow trained in use of FASP. Clinical indication was broadly split into malignant and non-malignant, 64% vs.36% respectively. Identified indications include; ascites 74% (302); urinary retention 19% (78); constipation or overflow 5% (9); deep vein thrombosis 1% (5); pleural effusion <1% (3); assessment of mass <1% (2) and spontaneous bacterial peritonitis <1% (1). 41% of the 302 ultrasounds for ascites, resulted in paracentesis. Major and minor complications rates, 0% vs. 8% respectively, were reviewed over 4 weeks. Failure of procedure was the highest minor complication rate at 2%. Persistent leakage from drain site, infection, local skin reaction and an asymptomatic drop in blood pressure had complication rates of <1% each. Data trends show the number of ultrasounds performed each year is decreasing, however, paracentesis rates remain relatively stable, suggesting more targeted use. Conclusions Community ultrasounds reduce hospital transfers, admissions and need to access hospital-based radiology services. With appropriately selected patients, the low complication rates, support continued use of community paracentesis. Patient views and preferences on the location of performing ultrasounds and procedures would be valuable. This combined with projected cost savings, has the potential to demonstrate and endorse the importance of these community-based services.

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