Obtaining venous access is a commonplace task in hospital settings, for the administration of intravenous medications. The most commonly used device is the intravenous cannula. Often patients are cannulated on admission and require new cannulas at regular intervals when they fail to function or present an infection risk. Not infrequently does cannulation pose a significant challenge for medical and nursing staff, particularly in cases of peripheral oedema, obesity or previous cytotoxic therapy. Multiple unsuccessful attempts can cause pain and distress to patients. Ward-based staff on occasion ask anaesthetic colleagues for assistance in difficult cases, who have particular experience in vascular access through various means including with ultrasound guidance (eg. central venous cannulation). While proficiency in utilising ultrasound for this purpose is more common among anaesthetists this technology is increasingly available in other hospital settings. Studies have demonstrated increased success rates in difficult cases, with fewer punctures required and increased patient satisfaction, when ultrasound guidance is used.1
A pilot teaching programme was provided to junior medical staff to increase awareness of vascular access techniques including the use of ultrasound guidance. The programme was advertised to core trainees as well as foundation trainees and delivered in a Simulation Centre setting. The ninety-minute session began with seminar discussions of practical aspects of vascular access, equipment available and ultrasound theory. This was followed by small-group hands-on training on deep vein models using ultrasound guidance to aid cannulation. Having offered time for practice participants were encouraged to use ultrasound technology in their jobs. At an interval following the session participants were surveyed to assess whether they used these skills, what difficulties they found and whether the course heightened their technical abilities in their day-to-day jobs.
Constantino G et al. Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access. Ann Em Med 2004 Dec;46(5):456–61.
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