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!