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Epidural/Echo/Coagulation

An audit of central venous cannulation in Papworth Hospital from March to May 2003: 063

Moore, C. S.; Graham, J.; Cobain, J.; Gray, S.

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European Journal of Anaesthesiology: June 2004 - Volume 21 - Issue - p 31
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Introduction: NICE [1] guidelines published in September 2002 recommend that ultrasound guidance is the preferred method for the insertion of central venous catheters (CVCs). Papworth currently uses the anatomical landmark method for insertion of CVCs. This audit is to establish the quality of our practice by assessing the success and complication rates in order to determine whether introducing ultrasound locating devices to Papworth would be beneficial.

Method: Anaesthetic specialist registrars and consultants were asked to complete an audit form for every CVC insertion during the 3 month audit period 10/03/03-31/05/03. Data gathered included patient demographics, anaesthetists' experience, site attempted, number of attempts, use of a seeker needle, previous CVCs and complications. Where two CVCs were inserted at the same time in the same patient, the second catheter has not been analysed.

Results: In total, 476 forms were completed during the audit period, which we estimate to be 80% compliant. These forms gave details of 505 approaches including 2nd and 3rd attempts. Of these, 481 used anatomical landmarks, one used pre-procedure ultrasound and 23 forms did not specify but it is assumed it would have been the anatomical landmark method. All but one patient was successfully cannulated. 68 patients had 2 CVCs inserted (CVC and Pulmonary Artery (PA) catheter). All internal jugular approaches were from the anterior but height was not specified. Vessels attempted, success rates and complication rates are shown in table 1; number (%).

Table
Table:
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Discussion: The data this audit has collected has confirmed that the current practice at Papworth Hospital using the anatomical landmark method for CVC insertion is acceptable with both the success and complication rates being comparable to findings in other published audits. However, it is possible that the 20% of CVC insertions that the audit did not capture could have been the cases with higher complication rates.

Reference:

1 National Institute for Clinical Excellence (NICE) Guidance on the use of ultrasound locating devices for placing central venous catheters. Technology Appraisal Guidance September 2002; 49.
© 2004 European Society of Anaesthesiology