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Welcome to the BSUH NHS Trust Online Bulletin, October 2005

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The Royal Sussex County Hospital, Brighton
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Hurstwood Park Neurosciences Centre, Haywards Heath



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New cannulation training could save lives

Paul Marchant demonstrates the use of ultrasound in venepuncture with the aid of colleague Anthony Lebray.

ALL Accident and Emergency nurse practitioners who cannulate should be trained in a new practice that could save lives and prevent morbidity.

That’s the view of Paul Marchant, senior operating department practitioner at Hurstwood Park Neurological Centre.

Paul says the use of ultrasound technology to achieve safer vascular access has been confined mainly to consultant clinicians and is a very much an under used adjunct for safe practice for all types of vascular access devices.

Using ultrasound ensures the needle enters the vein first time, while the practitioner guiding the needle visualises it entering the vein on the VDU screen of the ultrasound scanner.

 "The person placing the cannulae will avoid hitting an artery or nerve because they can see directly where it is situated," he says. "This is good for radial artery cannulation in theatre and A&E, as well as placing cannulae for potentially problematic patients.

"A&E should also have its own dedicated Ultrasound machine for vascular access for all the staff that cannulate. "This could reduce the number of ‘cut downs’ and central venous devices via the internal jugular vein.

"It is possible to place a drum catheter to measure central venous pressure and to give emergency medication into the central circulation via the anticubital fossa veins using ultrasound and micro introducers (seldinger technique) this technique could prevent pneumothorax and carotid arterial puncture.

"Drum catheters are not always easy to place because of the size of the needle which is large. There is now a new method using micro introducers that allow easer access in patients that display no visible veins in conjunction with ultrasound."

Paul has been using ultrasound in placing Peripherally Inserted Central Catheters for the last 14 months. Some of the patients referred to him have been stuck up to 17 times previously, which he says, causes a lot of distress to the patient and trauma to the peripheral vessels.

 "I have placed nearly 100 peripherally inserted central catheters on patients that have very difficult peripheral access with great success and feel other practitioners would benefit their patients and their clinical practice if they adopted this revolutionary technique which is not wide spread in this country at the moment."

A one day Ultrasound vascular access workshop and training in this new technique for those currently cannulating and placing intravascular devices will be available in January 2006 at Princess Royal Hospital. Contact Paul Marchant Bleep 046 for details or Paul.marchant@bsuh.nhs.uk

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