Chapter 17: Vascular access devices: insertion and management
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Source: Adapted from National Patient Safety Agency (www.npsa.nhs.uk). © Crown copyright. Reproduced under the Open Government Licence v2.0. For updates see www.england.nhs.uk.
Clinical governance
In 2008 the National Patient Safety Agency (NPSA) published a rapid response report that highlighted the many potential errors associated with the use of arterial cannulas. Various recommendations were given and immediate actions mandated to be put in place by January 2009 (Thillainathan and Mariyaselvam [437]) (Box 17.9).
In order to minimize the risks associated with arterial cannulation, sampling should only be done by competent trained staff (Cole and Johnson [81], NPSA [360]).
Box 17.9
Actions required by the National Patient Safety Agency when using arterial catheters
- Sampling from arterial devices is risky and should only be undertaken by competent trained staff. Trusts should raise awareness of the risks and review local guidelines. These should include criteria for requests for blood gas analysis, sampling technique, monitoring and interpretation of results (including unexpected findings).
- Arterial infusion sets must be identified clearly. This means labelling or use of safety solutions, such as marked sets, which have been adopted by some trusts.
- Any infusion (or additive) attached to the arterial catheter must be prescribed before administration. Further checks should be made at regular intervals and key points (such as shift handover).
- Staff should only use 0.9% sodium chloride to keep catheters open.
- Labels should clearly identify the contents of the infusion bags, even when pressure bags are used. Over time, the manufacturers should develop a universal system to address this problem.
