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Arterial catheter audit

Arterial catheter audit

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Arterial catheter audit

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  1. Arterial catheter audit C Doherty, J Rigg, J Boulton Critical Care Unit, Stockport NHS Foundation Trust 28th November 2011

  2. Evidence Ashton J et al(2) RCT 32 patients. NS versus Hep 10u/ml no sig difference in patency or phlebitis. More bleeding with hep Niesen KM et al(3) RCT 73 patients. NS versus Hep 10u/ml. No sig difference

  3. Evidence Clifton GD et al(4) DB RCT 30 patients saline versus heparin 4u/ml, flow 3ml/hr. Sig difference in catheter survival rates with hepsal resulting in longer patency Whitta RKS et al(5) RCT 65 patients. Saline versus hep 1u/ml, flow 3ml/hr.No difference in life span or function American association of Critical care nurses(6)RCT hep versus saline.5139 patients. Sig difference. Hepsal better Patency, longer lifespan

  4. Regional practice

  5. Audit design • Inclusion criteria – all arterial catheters inserted at Stepping Hill Hospital managed up to removal by critical care unit • Set standard for thrombosis rate <= 5% • Measure thrombosis rate using saline as flush solution • If thrombosis rate exceeds 5%, re-introduce heparinised saline as flush solution and undertake audit again • Compare thrombosis rates using different solutions

  6. Audit progress • Audit ran for two consecutive six week periods between October 1st and December 31st 2010 • 128/130 potential patients reviewed • 157 arterial catheters were valid for analysis

  7. Reason for removal

  8. Demographics

  9. Site of insertion

  10. Main results p value Chi2 test = 0.000

  11. Lifespan of arterial catheters p value Mann Whitney U test = 0.000

  12. Consequences

  13. Conclusions • Heparinised saline is more effective than saline in reducing thrombosis in arterial catheters • Use of saline as flush solution led to examples of poor practice

  14. References 1.Rapid Response Report NPSA/2008/RRR002. Natioanl Patient Safety Agency. April 2008 2.Ashton J et al. Effects of heparin versus saline solution on intermittent infusion device irrigation. Heart Lung. 1990;19:608-612 3.Niesen KM et al. The Effects of heparin versus normal saline for maintaining peripheral intravenous locks in pregnant women. J Obstet Gynecol Neonatal Nurs. 2003;32:503-508 4.Clifton GD et al. Compariosn of normal saline and heparin solutions for maintenance of arterial catheter patency. Heart Lung. 1991;20:115-118 5.Whitta RKS et al.Comparison of normal or heparinised saline on function of arterial lines. Crit Care Resusc. 2006;8:205-208 6. American association of Critical care nurses. Evaluation of the effects of heparinised and nonheparinised flush solutions on the patency of arterial pressure monitioring lines: the AACN Thunder Project. Am J Crit Care. 1993;2:3-15.