arterial catheter audit
DESCRIPTION
Arterial catheter audit. C Doherty, J Rigg, J Boulton Critical Care Unit, Stockport NHS Foundation Trust 28 th November 2011. Evidence. Ashton J et al (2) RCT 32 patients. NS versus Hep 10u/ml no sig difference in patency or phlebitis. More bleeding with hep - PowerPoint PPT PresentationTRANSCRIPT
Arterial catheter audit
C Doherty, J Rigg, J BoultonCritical Care Unit, Stockport NHS Foundation Trust
28th November 2011
Evidence
Ashton J et al(2) RCT 32 patients. NS versus Hep 10u/ml no sig difference in patency or phlebitis. More bleeding with hep
Niesen KM et al(3) RCT 73 patients. NS versus Hep 10u/ml. No sig difference
EvidenceClifton GD et al(4) DB RCT 30 patients saline versus heparin4u/ml, flow 3ml/hr. Sig difference in catheter survival rates withhepsal resulting in longer patency
Whitta RKS et al(5) RCT 65 patients. Saline versus hep 1u/ml, flow3ml/hr.No difference in life span or function
American association of Critical care nurses(6)RCT hepversus saline.5139 patients. Sig difference. Hepsal betterPatency, longer lifespan
Regional practiceUHSM HepsalBlackpool HepsalHope HepsalOldham HepsalTameside* HepsalBlackburn SalineBolton SalineBurnley* SalineBury* SalineLancaster SalineMacclesfield SalineMRI SalineNMGH SalinePreston SalineRochdale SalineStockport SalineWigan Saline
Audit design• Inclusion criteria – all arterial
catheters inserted at Stepping Hill Hospital managed up to removal by critical care unit
• Set standard for thrombosis rate <= 5%
• Measure thrombosis rate using saline as flush solution
• If thrombosis rate exceeds 5%, re-introduce heparinised saline as flush solution and undertake audit again
• Compare thrombosis rates using different solutions
Audit progress• Audit ran for two
consecutive six week periods between October 1st and December 31st 2010
• 128/130 potential patients reviewed
• 157 arterial catheters were valid for analysis
Reason for removal
Reason for removal Number
Dislodged 5
Not required 98
Suspected infection 8
Thrombosed 45
Vascular insufficiency 1
Total 157
Demographics
Saline Heparinised saline
p value Chi2
test
Number 77 80
Average age 60.6 57.3
Ratio Male to Female 0.61 0.62
Average APACHE II score 20.0 21.1
Average predicted mortality rate 0.34 0.37
Ratio planned admissions 0.40 0.21 0.009
Ratio patients receiving intensive care 0.43 0.64 0.008
Site of insertion
Right Left
Brachial 5 7
Radial 58 84
Femoral 2 0
Dorsalis pedis 1 0
Saline Heparinised saline
Ratio radial 0.88 0.94
Number of arterial
catheters
Number of patients
1 100
2 36
3 9
4 12
Total 157
Main results
p value Chi2 test = 0.000
Lifespan of arterial catheters
p value Mann Whitney U test = 0.000
Consequences
Conclusions
• Heparinised saline is more effective than saline in reducing thrombosis in arterial catheters
• Use of saline as flush solution led to examples of poor practice
References1.Rapid Response Report NPSA/2008/RRR002. Natioanl Patient Safety Agency. April20082.Ashton J et al. Effects of heparin versus saline solution on intermittentinfusion device irrigation. Heart Lung. 1990;19:608-6123.Niesen KM et al. The Effects of heparin versus normal saline for maintainingperipheral intravenous locks in pregnant women. J Obstet Gynecol NeonatalNurs. 2003;32:503-5084.Clifton GD et al. Compariosn of normal saline and heparin solutions formaintenance of arterial catheter patency. Heart Lung. 1991;20:115-1185.Whitta RKS et al.Comparison of normal or heparinisedsaline on function of arterial lines. Crit Care Resusc. 2006;8:205-2086. American association of Critical care nurses. Evaluation of the effects ofheparinised and nonheparinised flush solutions on the patency of arterialpressure monitioring lines: the AACN Thunder Project. Am J Crit Care.1993;2:3-15.