Download feature article by Dr Eleri Davies - 1000 Lives Plus

Improving care through reducing use of
cannulas and catheters
Dr Eleri Davies, Director of the Welsh Healthcare Associated
Infections Programme and a member of the 1000 Lives Plus
Faculty, explains why this work and campaign is so
important.
The use of devices like urinary catheters and intra-venous
cannulas are often an important part of treatment for many
patients.
An urinary catheter is a small tube often inserted into a patient’s bladder to
relieve them of urine following an operation or during an illness. Intra-venous
cannulas are inserted into the vein to allow intravenous medicines and fluids to be
given.
Unfortunately, both devices carry a small risk of infection because they can allow
bacteria into the body.
Reducing risk of infection
That’s why the work currently being carried out by NHS Wales staff across health
boards to improve the use of these devices, and reduce numbers being used, is so
important. It will ensure we are doing all we can to reduce the risk of infection to
patients.
It has been introduced by 1000 Lives Plus, the national programme which is
supporting organisations and individuals to deliver the highest quality and safest
healthcare for the people of Wales.
I am fully behind this work, as I know from personal experience what can happen
when a cannula is left in longer than necessary.
As a junior doctor, many years ago now, I admitted a patient in acute heart failure
who had heart valve disease.
I knew I needed to give medication to treat the heart failure and that the best way
of doing this was through an intra-venous cannula.
I inserted the device and the patient was admitted to the coronary care unit to be
stabilised and the patient improved.
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At this point the patient was well enough to be transferred to a ward and no longer
needed intra-venous medications, so the intra-venous cannula could possibly have
come out.
However, either because the ward was busy or that it was felt that it would be
best to leave the cannula in place in case further treatment became needed again,
it was not removed and the patient developed an infection.
The infection spread rapidly from the cannula into the patient’s blood and also
infected the already damaged heart valves which meant emergency heart valve
replacement surgery was needed.
Thankfully the patient survived the infection and the surgery, and was eventually
discharged from hospital.
Salutary lesson
The experience however, left an indelible print on my mind and was a salutary
lesson in the unintended harm that can result from medical devices, needed for
treatment, but that can lead to problems if left in too long.
The incident sparked in me a fervent interest in infection control and I am
wholeheartedly behind this new work to improve the way we deliver care.
By stopping, thinking and removing a device when appropriate, we really can help
to save lives and avoid patients suffering unnecessary harm.
Organisations have been implementing two new care bundles – a set of
interventions that work better together than separately – to improve care and
reduce infections.
Checklist
Staff are also being encouraged to use a checklist each time for every patient to
ensure the correct decision is made for them.
The work is already is showing signs of success with fewer
devices being inserted and infections reducing.
There are always going to be times when the insertion of an
urinary catheter or intravenous cannula is the best course of
action for patients and on occasions complications from the
use of medical devices may be unavoidable. However we
must minimise the risks as much as possible.
This article is
available on the
Resource CD for
you to use in your
internal
communications.
Further information is available at www.1000livesplus.wales.nhs.uk/STOP
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