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!