title: Effect of the implementation of NICE guidelines for ultrasound guidance on the complication rates associated with central venous catheter placement in patients presenting for routine surgery in a tertiary referral centre.
abstract: BACKGROUND
  The National Institute for Clinical Excellence (NICE) guidelines of 2002 recommended the use of ultrasound (US) for central venous catheterization in order to minimize complications associated with central line placement. An ongoing audit of line placement by anaesthetists in the theatre complex of a tertiary referral centre looked at the associated complication rates. The objective of the study was to compare complication rates pre- and post-implementation of NICE guidelines.
  
  
  METHODS
  This prospective, single centre audit looked at all patients in whom a central venous catheter was placed for surgery. Complication rates were assessed for procedures that were performed pre- and post-implementation of NICE guidelines. In total, 438 patients were identified for the study, and the procedures were performed either by trainee or by consultant anaesthetists.
  
  
  RESULTS
  The pre- and post-implementation complication rates were 10.5% (16/152) and 4.6% (13/284), respectively, representing an absolute risk reduction of 5.9% (95% CI 0.5-11.3%). Comparison of those procedures in which US was used when compared with the landmark technique after implementation found a reduction of 6.9% in complications (95% CI 1.4-12.4%). The reduction in complication rates was larger for specialist registrars than for consultants (11.2% vs 1.6%).
  
  
  CONCLUSIONS
  The implementation of NICE guidelines has been associated with a significant reduction in complication rates in our tertiary referral centre. In the light of the cross-speciality evidence of US superiority and our results, it is imperative that routine use of US guidance becomes more widespread.
authors.affiliation: Department of Anaesthesia, The Royal Marsden NHS Foundation Trust, London, UK. timothy.wigmore@rmh.nhs.uk
authors.forename: T J
authors.initials: TJ
authors.lastname: Wigmore
authors.forename: J F
authors.initials: JF
authors.lastname: Smythe
authors.forename: M B
authors.initials: MB
authors.lastname: Hacking
authors.forename: R
authors.initials: R
authors.lastname: Raobaikady
authors.forename: N S
authors.initials: NS
authors.lastname: MacCallum
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D019317:Evidence-Based Medicine; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008131:London; D008485:Medical Audit; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013514:Surgical Procedures, Operative; D018084:Ultrasonography, Interventional