Appendix D. Detail on criteria for audit of the use of ultrasound locating devices for placing central venous catheters

Possible objectives for an audit

An audit on the appropriate use of ultrasound locating devices could be carried out to ensure that:

  • when a central venous catheter (CVC) is being inserted into the internal jugular vein (IJV) of an adult or a child in an elective situation, 2-dimensional (2-D) imaging ultrasound guidance is used

  • healthcare practitioners involved in the placement of CVCs using 2-D imaging ultrasound guidance have appropriate training

  • audio-guided Doppler ultrasound guidance is not used for CVC insertion.

If healthcare practitioners have agreed locally on the clinical circumstances where 2-D imaging ultrasound guidance is to be used when a CVC insertion is necessary, the audit also could be carried out to ensure that the technique is used as agreed locally.

Possible patients to be included in the audit and time period for selection

All patients who have a CVC inserted either in the IJV in an elective situation (or for any purpose on either an elective or emergency basis, if 2-D imaging ultrasound is more widely used) over a reasonable period of time for audit data collection, for example, for 1 to 3 months. A sample of patients stratified by clinical areas most likely to be involved, for example, critical care areas, theatres, and accident and emergency, could be used for the audit or the audit could be staged to include one clinical area at a time, working through all clinical areas.

Measures to be used as a basis for an audit

Criterion

Standard

Exception

Definition of Terms

1. 2-D imaging ultrasound guidance is used when a CVC is being inserted in the IJV in an elective situation

100% of patients with a CVC inserted in the IJV in an elective situation

None

Local clinical teams should agree on the types of elective situations to be included in the audit and should agree to any exceptions for the use of the technique such as an infant weighing less than 3 kg

2. The healthcare practitioner involved in the placement of the CVC is trained in the use of 2-D imaging ultrasound guidance

100% of patients having a CVC inserted

None

For audit purposes, it should be agreed at NHS Trust level how training to achieve competence in the technique is documented

3. Audio-guided Doppler ultrasound guidance is not used for CVC insertion

100% of patients having a CVC inserted

None

An additional measure that could be used when it has been agreed to use 2-D imaging ultrasound guidance for other clinical circumstances in which a patient has a CVC inserted is as follows.

Criterion

Standard

Exception

Definition of Terms

1. 2-D imaging ultrasound guidance is used when a CVC is being inserted

100% of patients having a CVC inserted for any purpose

None

Local healthcare practitioners may specify circumstances in which 2-D ultrasound guidance is to be used when a CVC is being inserted or may specify exceptions, for audit purposes

Calculation of compliance with the measure

Compliance with each measure described in the table is calculated as follows:

Number of patients whose care is consistent with the criterion plus the number of patients whose care is consistent with any locally agreed exception

/

Number of patients to whom the measure applies

X 100

Healthcare practitioners should review the findings of measurement, identify whether practice can be improved, agree on a plan to achieve any desired improvement and repeat the measurement of actual practice to confirm that desired improvement is being achieved.