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IV Cannulation of Patients with Fractured Neck of Femur

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

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IV Cannulation of Patients with Fractured Neck of Femur

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  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

  9. Results • Size

  10. Results • Grade of staff member inserting cannula

  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 • Re-Audit @ 6months

  16. Re-Audit • 50 patients • Significant change in practice (p<0.05)

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

  18. Questions?Thank you!

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