7 Implementation and audit
7.1 NHS Trusts in which CVCs are used, all those who routinely insert CVCs and those responsible for clinical training programmes should review policies and practices regarding the insertion of CVCs to take account of the guidance set out in Section 1. The recommendations in this guidance will represent a significant service development for most NHS organisations. The Appraisal Committee has advised the Institute that the nature of the resource consequences of the guidance and the time it will take to put them in place should be brought to the attention of the Department of Health and the Welsh Assembly Government.
7.2 Local guidelines or care pathways which relate to the use of CVCs should incorporate the guidance set out in Section 1.
7.3 To enable healthcare practitioners to audit their own compliance with this guidance, it is recommended that a system is available to identify patients who have a CVC inserted in either an elective or an emergency situation.
When a CVC is being inserted into the IJV of an adult or a child in an elective situation, 2-dimensional (2-D) imaging ultrasound guidance is used.
All healthcare practitioners involved in the placement of CVCs using 2-D imaging ultrasound guidance undertake appropriate training to achieve competence in this technique.
Audio-guided Doppler ultrasound guidance is not used for CVC insertion.
7.5 All NHS Trusts in which CVCs are used should identify the number of 2-D imaging ultrasound units required and the appropriate location for each unit, should plan to train a sufficient number of healthcare practitioners from a range of disciplines in the proper use of the units and should identify other financial and service implications of implementing the guidance in Section 1.
7.6 Healthcare practitioners should consider the most appropriate method of CVC insertion that is in the best interest of the patient in his or her specific clinical situation, particularly in terms of minimising the risk of adverse events such as failed catheter placements or catheter placement complications. Trusts should recognise that the decision to use 2-D imaging ultrasound guidance or the landmark method will be informed by:
the competence and previous experience of the operator(s)
the anatomical site of CVC insertion and other anticipated technical difficulties
the urgency of clinical need.