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Download IV Cannulation of Patients with Fractured Neck of
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IV Cannulation of Patients with Fractured Neck of Femur Michael Barrett Core Surgical Trainee Year 1 Medway Maritime Hospital Aims of Presentation • Introduction • Guidelines • Methods • Results • Recommendations for change • Re-Audit • Conclusions Introduction • • • • Analgesia Fluid resus Appropriate site / size Not in Antecubital Fossa (ACF) Why not in ACF? • • • • • • Compromised flow of IV fluids Increased risk of neurovascular injury Preservation of ACF in case of emergency Mechanical phlebitis Increased risk of infection Reduced patient comfort Guidelines • Local: • Did not recommend a preferred site • National: • Peripheral > than ACF Aims • Review appropriateness of IV cannulation in patient with fractured neck of femur. Methods • Prospective • NOF admissions • Reviewed notes / patient • Who? • Site? • Size? Results • 97 patients • Site Location Peripheral ACF % Placed 47% 53% Results • Size Cannula Size % of that size Blue (14G) 34% Pink 66% Green 0% Grey 0% Results • Grade of staff member inserting cannula Grade % Placed SHO 85% F1 10% Nurse 3% Results • Poor practice with most people cannulating ACF as routine • Blue (14G) in ACF inappropriate • So why Questionnaire Questionnaire • AED / F1s / Ortho SHOs / Medical SHOs • Non-Emergency • ACF cannulation - Easy • Anaesthetists: Cons - SHO • Hand - personal clinical experience Why? • Cannulation teaching Recommendations for change • Discussion at the IV access group meeting • Change to local guidelines • Change to teaching session • Staff re-education • Re-Audit @ 6months Re-Audit • 50 patients • Significant change in practice (p<0.05) Location Peripheral ACF % Placed 71% 12.5% Conclusion • Significant patient safety issue • Simple measures to correct practice • Good uptake with staff Questions? Thank you!
