IV Cannulation of Patients with Fractured Neck of Femur Michael Barrett Core Surgical Trainee Year 1...
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Transcript of IV Cannulation of Patients with Fractured Neck of Femur Michael Barrett Core Surgical Trainee Year 1...
IV Cannulation of Patients with Fractured Neck of
FemurMichael Barrett
Core Surgical Trainee Year 1Medway Maritime Hospital
Aims of Presentation
•Introduction
•Guidelines
•Methods
•Results
•Recommendations for change
•Re-Audit
•Conclusions
Introduction
•Analgesia
•Fluid resus
•Appropriate site / size
•Not in Antecubital Fossa (ACF)
Why not in ACF?•Compromised flow of IV fluids
• Increased risk of neurovascular injury
•Preservation of ACF in case of emergency
•Mechanical phlebitis
• Increased risk of infection
•Reduced patient comfort
Guidelines
•Local:
•Did not recommend a preferred site
•National:
•Peripheral > than ACF
Aims
•Review appropriateness of IV cannulation in patient with fractured neck of femur.
Methods
•Prospective
•NOF admissions
•Reviewed notes / patient
•Who?
•Site?
•Size?
Results
•97 patients
•Site
Location % Placed
Peripheral 47%
ACF 53%
Results
•Size
Cannula Size % of that size
Blue (14G) 34%
Pink 66%
Green 0%
Grey 0%
Results
•Grade of staff member inserting cannula
Grade % Placed
SHO 85%
F1 10%
Nurse 3%
Results
•Poor practice with most people cannulating ACF as routine
•Blue (14G) in ACF inappropriate
•So why
Questionnaire
Questionnaire
•AED / F1s / Ortho SHOs / Medical SHOs
•Non-Emergency
•ACF cannulation - Easy
•Anaesthetists: Cons - SHO
•Hand - personal clinical experience
Why?
•Cannulation teaching
Recommendations for change
•Discussion at the IV access group meeting
•Change to local guidelines
•Change to teaching session
•Staff re-education
•Re-Audit @ 6months
Re-Audit
•50 patients
•Significant change in practice (p<0.05)
Location % Placed
Peripheral 71%
ACF 12.5%
Conclusion
•Significant patient safety issue
•Simple measures to correct practice
•Good uptake with staff
Questions?Thank you!