IV Cannulation of Patients with Fractured Neck of

FemurMichael Barrett

Core Surgical Trainee Year 1Medway 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 % Placed

Peripheral 47%

ACF 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 % Placed

Peripheral 71%

ACF 12.5%

Conclusion

•Significant patient safety issue

•Simple measures to correct practice

•Good uptake with staff

Questions?Thank you!