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Type and Title of Submission


Title:

Central venous cannulation - transforming training and safety

Description:

I campaigned for and obtained portable ultrasound equipment whilst working at Northampton general hospital. I then wrote the guidelines for use and devised a training program for the use of portable ultrasound in central venous cannulation.

Category:

Clinical

Does the submission relate to the general implementation of all NICE guidance?

No

Does the submission relate to the implementation of a specific piece of NICE guidance?

Yes

Full title of NICE guidance:

TA49 - Central venous catheters - ultrasound locating devices

Category(s) that most closely reflects the nature of the submission:

Implementation policy

Is the submission industry-sponsored in any way?

No


Description of submission


Aim

To ensure every central venous catheter is inserted under ultrasound guidance using a dedicated procedure pack and by an appropriately trained operator.

Objectives

1) Train all junior doctors how to use ultrasound for central venous cannulation. 2) Implement dedicated procedure packs. 3) Complement with dedicated and detailed guidelines.

Context

Prior to this intervention central venous cannulation was undertaken by a variety of personnel with a vast difference in experience and training. ultrasound was not used and complications including one death had occurred in the recent past.

Methods

1) I devised, implemented and lead a practical training program to teach all junior doctors (and some consultants!) how to use ultrasound for central venous cannulation. 2) We designed a dedicated procedure pack and sought quotes from industry. Ensuring appropriate funding was challenging as the packs were to be used across many clinical areas but once trialled and audited the benefit was clear and the packs introduced. 3) A detailed guideline on the pre-procedure care, line insertion and post-procedure care was written and made available on the trust intranet. Regular update training sessions were arranged.

Results and evaluation

Rolling continuous audit of every central venous cannulation procedure was commenced and remains in place. This has helped refine both the training and the procedure packs. The intervention has reduced complications of central venous cannulation considerably and improved doctors understanding of the procedure and its risks. The use of portable ultrasound has now evolved to arteria line, chest drain and ascitic drain insertion as doctors gain confidence using the equipment. Furthermore by demonstrating the effectiveness of a practical training program using optimised equipment we have now planned to replicate this for other important procedures such as chest drain insertion and temporary pacing.

Key learning points

1) Involve all interested parties early - I sought advice and input from ITU, A+E, theatres, medicine and surgery - all places where central venous catheters are inserted. 2) Explore creative funding opportunities - the first ultrasound machine was rented using charitable monies. Once its benefits became clear the trust were happy to provide further machines. 3) Arrange formal training - doctors have very little formal, accredited and evaluated training in practical procedures and find it stimulating and extremely helpful. 4) Maintain your standards and do not compromise - many hurdles have to be crossed and it can be difficult.

Contact Details

Name:James Newton
Job Title:SpR Cardiology
Organisation:John Radcliffe Hospital
Address:Headington
Town:Oxford
Postcode:OX3 9DU
Phone:01865222935
Email:jim.newton@orh.nhs.uk

 

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This page was last updated: 17 September 2009

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.