Impact of NICE guidance on the provision of ultrasound machines for central venous catheterization
Editor—We read with interest the editorial by Bodenham1 on the training and accreditation issues surrounding the use of ultrasound imaging by anaesthetists. There has been extensive debate regarding ultrasound guidance for the placement of central venous catheters (CVCs) ever since September 2002 when the National Institute for Clinical Excellence (NICE) published its recommendations for the use of ultrasound locating devices for the placement of CVC.2 Two years later, in an editorial in this journal commenting on the controversies regarding the implementation of guidelines, Scott3 concluded that ‘ultrasound guidance for venous and arterial catheterization is here to stay’. He went on to talk about a ‘new generation of anaesthetists, no more likely to attempt central venous cannulation without ultrasound guidance than they would be to embark on an anaesthetic without an ECG, a pulse oximeter and capnograph’. NICE guidelines should be adhered to within 3 months of publication and if the hospitals do not respond by implementing the correct in place, there is little point printing these guidelines. A survey measuring the impact of the NICE recommendations of September 2002 was conducted by Abacus International in July 2004, almost 2 yr after its publication.4 A postal questionnaire was sent out to 250 anaesthetists registered with the Royal College of Anaesthetists. The survey showed that 36% of the anaesthetists surveyed felt they had appropriate resources in place for the use of ultrasound technology; however, 46% felt they had little or no access to ultrasound technology. Of these anaesthetists surveyed, only 28% considered themselves compliant in the technique of ultrasound-guided CVC insertion. Most of the anaesthetists polled agreed that everyone involved in CVC placement using ultrasound should undertake appropriate training. However, two-thirds of them rated the level of training provided for medical staff on two-dimensional ultrasound CVC insertion as poor or non-existent. In August 2005, NICE reviewed its original guidance and decided to make it static.5The foremost requirement to follow a guideline is to have access to the necessary equipment. In January 2006, we conducted a survey, by telephone, of 195 hospitals in the UK to find out the ready availability of ultrasound machines for CVC insertion. The method used was to call the anaesthetic registrar on-call for each hospital and ask whether their department owned an ultrasound machine in the intensive care unit (ICU) and if not, was there one readily available in theatres designated for CVC insertion. The results showed that 185 hospitals (95%) had ultrasound machines readily available for inserting CVCs. Our survey also showed that only six of the hospitals that owned an ultrasound machine did not have one permanently on site in ICU and needed to collect it from theatres when required.
In conclusion, NICE guidance has had a large and positive impact on the provision of ultrasound machines for the guidance of CVC placement. We are now looking at whether there has been an increased uptake of training and compliance with the guidelines.
Redhill, UK
*E-mail: joneskurian{at}yahoo.co.uk
References
1 Bodenham AR. Ultrasound imaging by anaesthetists: training and accreditation issues. Br J Anaesth 2006; 96:414–17
2 National Institute for Clinical Excellence. NICE technology appraisal guidance No 49: Guidance on the use of ultrasound locating devices for placing central venous catheters. 2002.London NICE Available from www.nice.org.uk/pdf/ultrasound_49_GUIDANCE.pdf
3 Scott DHT. The king of the blind extends his frontiers. Br J Anaesth 2004; 93:175–7
4 Abacus International Survey. A survey measuring the impact of NICE guidance 49: the use of ultrasound locating devices for placing central venous catheters. 2004.London NICE Available from www.nice.org.uk/page.aspx?0=259506
5 National Institute for Clinical Excellence. NICE technology appraisal guidance No 49: ultrasound locating devices for placing central venous catheters. Proposal to move guidance to the static list. 2005.London NICE Available from www.nice.org.uk/pdf/ta049reviewproposal.pdf
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