Shared learning database

John Radcliffe Hospital
Published date:
September 2009

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.

Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

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

Reasons for implementing your project

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.

How did you implement the project

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.

Key findings

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

James Newton
SpR Cardiology
John Radcliffe Hospital

Tertiary care
Is the example industry-sponsored in any way?