AAGBI Safer Vascular Access 2016: Comments invited from members

A new draft guideline on AAGBI Safer Vascular Access 2016 is in its final draft stage and comments are invited from members. Please read the draft and submit comments to workingparties@aagbi.org. All comments submitted will be considered before a final version is brought before the AAGBI Council for approval. The closing date for comment submission is 5pm on Tuesday 3 November.

Comments

comments of draft guideline

Hello,

Thank you for the opportunity to comment on te guideline. First of all, I found it very useful. It has certainly clarifed a few things for me as well.

I would like to draw the pannel's attention to two more complications that were reported in A&A:

1.Guido Turi, MD, Paolo Tordiglione, MD, and Fabio Araimo, MD. Anterior Mediastinal Central Line Malposition.Anesth&Analg.July 2013 Volume 117 Number 1

2.Marcel Schepers, MD,* Marcel Vercauteren MD, PhD,* Dina De Bock, MD,† Inez Rodrigus, MD, PhD,† David Vanderplanken, MD,‡ and Michael Camerlinck, MD§.Inadvertent Intrathecal Placement of a Pulmonary Artery Catheter Introducer. Anesth&Analg.July 2013 Volume 117 Number 1.

I apologise for the format of the references ( I expected I can attach the articles to this email).

I was wondering if given the perceived higher risk complication rate with higher gauge catheters, such as Swan sheath introducers (tend to be inserted in a hurry for rapid volaemic resuscitation) or Vascaths for CVVH, whether it would be wise to have them done by seniors or under compulsory USS guidance (I noticed the word "should" used in  the current guideline uses when it comes to USS use).

Traditionally cardiac units would make their trainees use landmark tachnique for central catheter placing (personal experience from the regional unit). I was wondering what is the view of ACTA on it and whether there is a surveuy of UK cardiac units with regards to CVP insertion practices and complcation rates.  Arterial puncture in cases where the patient then undergoes bypass with IV heparin admiistration in excess of 30,000 units bolus would probably lead to more significant complications.

In the infection paragraph, you kept it safe and left it to departamental policies. I was wondering if we can have a bit more detail than that.

Finally, 2 typo errors: on Service provision section, on Acute care, there is spacing between Hospitals "should organise". The other is on Pneumothorax paragraph: at the beginning , pneumothorax is spelled pneumothorac.

I do appologise is my suggestions are petty or uselss. Please ignore them otherwise.

BW,

Monica Morosan

Consultant Obstetric Anaesthetist

NNUH