A national survey of the use of ultrasound locating devices for placing central venous catheters

Abstract

The National Institute for Health and Clinical Excellence (NICE) has published guidelines on the use of ultrasound locating devices for placing central venous catheters [1]. A survey in 2004 found that only 28% of hospitals were compliant with the guidelines and 45% felt it would take more than 12 months to implement them [2]. We therefore decided to re-survey hospitals throughout the UK. A questionnaire was sent to the clinical director of 294 anaesthetic departments between September 2005 and January 2006 with one follow-up mailing to those departments that had not replied. Information collected included whether the department had ultrasound locating devices, whether there was training on the device, and whether there had been any critical incidents within the previous 12 months. The completed data were collated quantitatively onto a Microsoft Excel® database and descriptive results presented. The response rate was 68% (199/294). Of departments that replied, 86% (172/199) had ultrasound locating devices. In the 14% (27/199) of departments that did not have one, lack of funding was most frequently stated as the reason (67% (18/27)). Fifty-two percent (90/172) of departments with ultrasound locating devices stated that they had some (∼25%) anaesthetists trained in their use, and 41% (71/172) had most (∼50–75%) anaesthetists trained. Training was provided by the manufacturer in 48% (83/172) of departments and/or an experienced colleague in 81% (140/172). Radiologists provided training to the anaesthetists in five (3%) of the 172 departments. Eighty-three percent (143/172) of respondents who had an ultrasound locating device felt that the training provided was ‘appropriate’. One or more critical incident had occurred during the previous 12 months in 54% (108/199) of departments (Table 1). Ultrasound locating devices had been used in 35% of these critical incidents. The National Institute for Health and Clinical Excellence expects the NHS to provide funding and resources within three months of guidelines’ being published. Our results show that, four years after publication of NICE guidelines, there has been a significant improvement (from 28% to 86%) in the number of departments that have access to ultrasound locating devices. However, 14% of trusts are still not compliant. The NICE guidelines state that healthcare practitioners should undertake ‘appropriate training to achieve competence’[1]. The high frequency of critical incidents when ultrasound locating devices were used to guide central venous cannulation (35%) may well be due to inadequate training. However, nearly all clinical directors (83%) thought that training provided in their departments was ‘appropriate’. This may have serious medicolegal implications.