10 Detail on criteria for audit of the use of ultrasound locating devices for placing central venous catheters
Possible objectives for an audit
An audit on the appropriate use of ultrasound locating devices could be carried out to ensure that:
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when a central venous catheter (CVC) is being inserted into the internal jugular vein (IJV) of an adult or a child in an elective situation, two-dimensional (2D) imaging ultrasound guidance is used
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healthcare practitioners involved in the placement of CVCs using 2D imaging ultrasound guidance have appropriate training
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audio-guided Doppler ultrasound guidance is not used for CVC insertion.
If healthcare practitioners have agreed locally on the clinical circumstances where 2D imaging ultrasound guidance is to be used when a CVC insertion is necessary, the audit also could be carried out to ensure that the technique is used as agreed locally.
Possible patients to be included in the audit and time period for selection
All patients who have a CVC inserted either in the IJV in an elective situation (or for any purpose on either an elective or emergency basis, if 2D imaging ultrasound is more widely used) over a reasonable period of time for audit data collection, for example, for 1 to 3 months. A sample of patients stratified by clinical areas most likely to be involved, for example, critical care areas, theatres, and accident and emergency, could be used for the audit or the audit could be staged to include 1 clinical area at a time, working through all clinical areas.
Criterion | Standard | Exception | Definition of terms |
---|---|---|---|
2D imaging ultrasound guidance is used when a CVC is being inserted in the IJV in an elective situation |
100% of patients with a CVC inserted in the IJV in an elective situation |
None |
Local clinical teams should agree on the types of elective situations to be included in the audit and should agree to any exceptions for the use of the technique, such as for an infant weighing less than 3 kg |
The healthcare practitioner involved in the placement of the CVC is trained in the use of 2D imaging ultrasound guidance |
100% of patients having a CVC inserted |
None |
For audit purposes, it should be agreed at NHS trust level how training to achieve competence in the technique is documented |
Audio-guided Doppler ultrasound guidance is not used for CVC insertion |
100% of patients having a CVC inserted |
None |
– |
An additional measure that could be used when it has been agreed to use 2D imaging ultrasound guidance for other clinical circumstances in which a patient has a CVC inserted is as follows.
Criterion | Standard | Exception | Definition of terms |
---|---|---|---|
2D imaging ultrasound guidance is used when a CVC is being inserted |
100% of patients having a CVC inserted for any purpose |
None |
Local healthcare practitioners may specify circumstances in which 2D ultrasound guidance is to be used when a CVC is being inserted or may specify exceptions, for audit purposes |
Calculation of compliance with the measure
Compliance with each measure described in tables 1 and 2 is calculated as follows:
Numerator divided by the denominator, multiplied by 100.
Numerator: Number of patients whose care is consistent with the criterion plus the number of patients whose care is consistent with any locally agreed exception.
Denominator: Number of patients to whom the measure applies.
Healthcare practitioners should review the findings of measurement, identify whether practice can be improved, agree on a plan to achieve any desired improvement and repeat the measurement of actual practice to confirm that desired improvement is being achieved.
ISBN: 978-1-4731-5619-7