Quality and Productivity case study

University Hospitals of Leicester NHS Trust
Publication Date
14 Nov 2016
Publication Type


A centralised, nurse-led vascular access team has been funded and set up. Three nurses within the Radiology Department at Leicester Royal Infirmary have been trained to insert and remove all vascular access devices using ultrasound and fluoroscopy guidance as standard. Sessions in a dedicated room were reserved for them to carry out this work and the new service was heavily publicised across the Trust. In the past these procedures were mainly carried out in wards and clinics, by various grades of medical staff, often using anatomical landmarks rather than image guidance. Infection control practices were varied and could be sub-optimal, and more junior staff often lacked skills and experience. Patients could also be referred unnecessarily to the anaesthetist's emergency list, thus blocking a theatre. Complications such as device failure, pneumothorax, arterial puncture and infection could stem from poor insertion technique or care and maintenance issues. The new service has helped to address these issues, improve device choice and increase cost savings due to reduced bed stays, reduced infection rates and reduced repetition of work. This service is offered on weekdays from 8.30am to 5.00pm to all patients requiring central venous access at Leicester Royal Infirmary. Also a more limited advice, troubleshooting and insertion service is on offer to the other two Leicester hospitals. Giving advice and training is a vital part of the Team's remit. The service is increasingly used by wards and clinics across the three Leicester hospitals. Currently the Vascular Access Team performs approximately 1000 of the 6000 central line insertions/removals per year across the Trust, a number that is expected to grow. They also provide an estimated 1000 episodes of device maintenance, which could mean assessing the device in situ, providing advice in person or over the phone. The Vascular Access Team does not perform all central line insertions, as this could compromise the skills of the medical staff and trainees across the Trust. However they do provide advice and training to such staff to help support the quality of the out-of-hours service. The range of patients who currently benefit are: Oncology and Haematology, particularly chemotherapy patients (approx 70% of the work) Cardiology: Endocarditis patients Medical Unit: Cellulitis patients Trauma and Orthopaedics Infectious Diseases Unit Diabetes Respiratory Diseases