1. IV Cannulation of Patients with Fractured Neck of Femur
Michael Barrett
Core Surgical Trainee Year 1
Medway Maritime Hospital

2. Aims of Presentation Introduction Guidelines Methods Results
Recommendations for change
Re-Audit
Conclusions

3. Introduction Analgesia Fluid resus Appropriate site / size
Not in Antecubital Fossa (ACF)

4. 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

5. Guidelines Local: Did not recommend a preferred site National:
Peripheral > than ACF

6. Aims
Review appropriateness of IV cannulation in patient with fractured neck of femur.

7. Methods Prospective NOF admissions Reviewed notes / patient Who? Site?
Size?

8. Results
97 patients
Site
Location
% Placed
Peripheral
47%
ACF
53%

9. Results Size Cannula Size % of that size Blue (14G) 34% Pink 66% Green0%
Grey

10. Results Grade of staff member inserting cannula Grade % Placed SHO 85%
10%
Nurse 3%

11. Results Poor practice with most people cannulating ACF as routine
Blue (14G) in ACF inappropriate
So why

12. Questionnaire

13. Questionnaire AED / F1s / Ortho SHOs / Medical SHOs Non-Emergency
ACF cannulation - Easy
Anaesthetists: Cons - SHO
Hand - personal clinical experience

14. Why?
Cannulation teaching

15. Recommendations for change
Discussion at the IV access group meeting
Change to local guidelines
Change to teaching session
Staff re-education
6months

16. Re-Audit 50 patients Significant change in practice (p<0.05)
Location
% Placed
Peripheral
71%
ACF
12.5%

17. Conclusion Significant patient safety issue
Simple measures to correct practice
Good uptake with staff

18. Questions? Thank you!