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 % Placed Peripheral 47% ACF 53%

Results Size Cannula Size % of that size Blue (14G) 34% Pink 66% Green 0% Grey

Results Grade of staff member inserting cannula Grade % Placed SHO 85% 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!