[Department of Error] Department of Error

Jaber S, Paugam C, Futier E, et al. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. Lancet 2018; 392: 31–40—In the second to last sentence of the Findings section of the Summary, and in the last paragraph of the Results section, the data for the Kaplan-Meier method estimate of survival by day 28 in the prespecified AKIN stratum reported in the parentheses should read as “…37% [95% CI 28–48] vs 54% [45–65]…” for the control group versus the bicarbonate group, respectively.

Thank you letters from recipients of the AMA Indigenous Medical Scholarship

It has made a huge difference

I am writing to you today to inform you that I have officially completed my studies at the University of Newcastle in the Bachelor of Medicine program as of the 7^th December 2018, and I would like to take this opportunity to say thank you to the Australian Medical Association for their support throughout my time at Newcastle University that made this endeavour possible with the Indigenous Peoples’ Medical Scholarship 2016.

I can still remember the day I received the phone call that I had been awarded the scholarship. I was studying in the library, trying to finish off that week’s ‘Working Problem’. I saw it was a Canberra phone number, and instantly became nervous. I can still remember saying to myself ‘is this real?’ as I never expected to be even considered for such an award, but nonetheless, it has made a huge difference to where I am today.

As a mature aged student with a family, the scholarship took the pressure off the financial strain of attending university, and allowed me to focus more on my studies at the time when it was needed the most. Previous to the scholarship, my usual routine was to attend university Monday to Friday, then work Friday and Saturday night shifts in as a Registered Nurse in the Intensive Care Unit at the Newcastle Mater Hospital. This left me with one day to spend time with my family, and catch up on any extra reading. The scholarship enabled me to scale back work, spend more time studying, but it also allowed me to spend extra time with my boys.

I was fortunate enough to secure a position as a Junior Medical Officer in the Hunter New England Local Health District, commencing on the 21^st January in 2019. This will keep me close to home at the present time, and I am looking forward to the challenge. Being an active member of the Wollotuka Institute at the University of Newcastle, I am also now looking forward to mentoring and tutoring Indigenous medical students in a new capacity so as to foster the next generation of Indigenous medical graduates.

Thank you once again to all the staff at the Australian Medical Association for making this dream possible.

Regards
Dr Darren Hartnett

*******************************

Continues to be the source of support that facilitates my passion to pursue medicine

This year was my first clinical year of medicine, where I was placed in Wagga-Wagga NSW. I have always been sure about pursuing rural and remote medicine – but being immersed in clinical medicine in rural NSW has only reaffirmed this more and made me more motivated!

Reading about the UNSW medicine program before I even gained entry, I was always very keen to be placed in Wagga. I placed it as my first preference and was lucky enough to get it [Wagga is becoming very popular among students!].

The relocation to Wagga from Wollongong was always going to be an expensive exercise; however, it was very comforting knowing that the transition would be supported by the AMA Indigenous medical scholarship. Throughout various placements this year, both within the hospital and the community, I have been exposed to the spectrum of health – and in particular health issues common in rural Australia such as Indigenous health and mental health.

An interest of mine has always been obstetrics, and I have made sure that this year I have had as much exposure as possible. As part of the UNSW medicine program, students are required to complete a 30-week independent learning project in their 4th year of study. I have been fortunate enough to have my proposal approved and will also be completing my research project in Wagga during 2019.

My research has an obstetric focus and will be assessing Indigenous foetal-maternal outcomes. I have not had much exposure to research however I am excited to learn more about rural obstetric medicine and am looking forward to the challenge next year! This year has also seen the budget allocate funding of a new medical school in Wagga-Wagga. I firmly believe this is a great opportunity to increase Indigenous medical student numbers as well as improving retention. As this has involved the current Wagga-Wagga rural clinical school I have been lucky enough to share my thoughts with the Dean of rural medicine.

This is something I have become quite passionate about as I truly believe that increasing the amount of Indigenous medical and allied health professionals will only aid in closing the gap between Indigenous and non-Indigenous health status. This is a passion which I will continue to lobby for. The AMA Indigenous scholarship has, and continues to be, the source of support that facilitates my passion to pursue medicine. Medicine is a challenging experience and sometimes a little daunting and overwhelming. Being a recipient of the AMA Indigenous Medical Scholarship is a constant source of motivation and an opportunity I am and will always be grateful for! Thank you again for your support and in assisting me throughout my medical studies and I look forward to 2019 as a proud recipient of the AMA Indigenous Scholarship.

Regards
James Chapman

indigenous-medical-scholarship-2019

Occurrence of and referral to specialists for pain-related diagnoses in First Nations and non-First Nations children and youth [Research]

BACKGROUND:

Indigenous youth have higher rates of chronic health conditions interfering with healthy development, including high rates of ear, dental, chest and musculoskeletal pain, as well as headache, arthritis and mental health issues. This study explores differences in pain-related diagnoses in First Nations and non–First Nations children.

METHODS:

Data from a study population of age- and sex-matched First Nations and non–First Nations children and youth were accessed from a specific region of Atlantic Canada. The primary objective of the study was to compare diagnosis rates of painful conditions and specialist visits between cohorts. The secondary objective was to determine whether there were correlations between early physical pain exposure and pain in adolescence (physical and mental health).

RESULTS:

Although ear- and throat-related diagnoses were more likely in the First Nations group than in the non–First Nations group (ear 67.3% v. 56.8%, p < 0.001; throat 89.3% v. 78.8%, p < 0.001, respectively), children in the First Nations group were less likely to see a relevant specialist (ear 11.8% v. 15.5%, p < 0.001; throat 12.7% v. 16.1%, p < 0.001, respectively). First Nations newborns were more likely to experience an admission to the neonatal intensive care unit (NICU) than non–First Nations newborns (24.4% v. 18.4%, p < 0.001, respectively). Non–First Nations newborns experiencing an NICU admission were more likely to receive a mental health diagnosis in adolescence, but the same was not found with the First Nations group (3.4% v. 5.7%, p < 0.03, respectively). First Nations children with a diagnosis of an ear or urinary tract infection in early childhood were almost twice as likely to have a diagnosis of headache or abdominal pain as adolescents (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.1–3.0, and OR 1.7, 95% CI 1.2–2.3, respectively).

INTERPRETATION:

First Nations children were diagnosed with more pain than non–First Nations children, but did not access specific specialists or mental health services, and were not diagnosed with mental health conditions, at the same rate as their non–First Nations counterparts. Discrepancies in pain-related diagnoses and treatment are evident in these specific comparative cohorts. Community-based health care access and treatment inquiries are required to determine ways to improve care delivery for common childhood conditions that affect health and development.

Vic-led study to investigate cancer return

A Melbourne-led study will investigate whether anaesthetic gas given to patients undergoing cancer surgery can fuel the disease to return.

About 5700 patients having lung or colorectal cancer surgery will take part in the five-year international study examining cancer recurrence rates when inhaled anaesthesia gas is used, compared to intravenous anaesthesia.

“It is imperative that this is explored in patient population as there is mounting evidence that surgical therapy and anaesthesia may adversely impact cancer outcomes,” chief investigator Professor Bernhard Riedel said on Sunday.

About 60 per cent of patients with these cancers will have a recurrence over five years, he said.

The study will bring together anaesthetists, surgeons, oncologists and research scientists from across the globe and it could lead a change surgical strategies globally.

Previous studies found that mice given anaesthetic gases had a 20 to 25 per cent cancer increased risk of recurrence inside their lungs, compared to those treated with intravenous anaesthesia.

Retrospective studies had found there was a five to 10 per cent recurrence in cancer patients who inhaled the gas, Prof Riedel told reporters at Peter MacCallum Cancer Centre.

“The evidence is not robust. We need to do this study,” he said.

“These gases don’t cause cancer. These gases add fuel to the fire.

“These volatile agents just add more inflammation and potentially immune suppressants for that brief period. So the underlying risk of having a cancer and maybe … little spots of cancer that can reoccur is what these volatiles may contribute to.”

Surgery is the most common treatment for cancer up to 80 cent of patients with the disease exposed to anaesthetic during treatment, the Australian and New Zealand College of Anaesthetists states.

Inhaled gas has been the primary techniques used by anaesthetists for decades, Prof Riedel noted.

More than 300,000 cancer operations are done in Australia each year and it is expected to increase over the next decade.

With the study results years away, the leading Victorian cancer hospital has already begun reducing its use of the inhaled anaesthesia in some cases.

“(But) having an experienced anaesthetist who knows the technique well is probably more important than trying to try techniques that aren’t familiar with them,” Prof Riedel said.

“It is not going to cure cancer. It is really a supportive strategy to help the cancer surgeons achieve best outcomes for their patients.”

MBS Review – Chance for your say

BY ASSOCIATE PROFESSOR ANDREW C MILLER, CHAIR, AMA MEDICAL PRACTICE COMMITTEE

The AMA support for a review of the MBS has always been contingent on it being clinician-led, with a strong focus on supporting quality patient care. This includes having the right mix of practising clinicians on each committee, with genuine input into a process of transparent decision making.

The AMA, of course, would like to see a review process that delivers a schedule that reflects modern medical practice, by identifying outdated items and replacing them with new items that describe the medical services that are provided today. In doing so, it is crucial that any savings from the MBS review be reinvested into the MBS, and that the review is not simply a savings exercise.

The MBS Review is by no means a small feat, undertaking to review 5,700 items, some which have not been reviewed in 30 years. Obviously, the outcomes of this herculean review not only impact on Government operations and budgets, but significantly affect the entire health system—the always difficult balancing act between the public and private health sectors, the vast number and range of medical practitioners, specialties and medical services, and of course the public.

It was noted by the AMA that the Senate estimates transcripts (30 May 2018) indicated about $600 million in Government savings from the MBS reviews over the 2017 and 2018 budgets, with only $36 million reinvested into new items.

With so much at stake the AMA, specialty colleges, associations and societies must all work individually, and together to hold the MBS Review clinical committees, Taskforce and Government to account on their considerations and recommendations. They cannot be based on anecdotal evidence and narrow perspectives, rather than on data, scientific or robust evidence, or extensive and lived perspectives.

In that vein, I thought it timely to provide a sample of some of the AMA work in this space.

MBS Review clinical committee reports – consultation timeframes

Within the last two months, the Department of Health has requested feedback from AMA on 25 MBS Review clinical committee reports. The reports included around 2,000 MBS items and more than 2,000 pages. The number of items reviewed in these reports are almost 40 per cent of the total number of items in the entire Medicare schedule.

The MBS Review Taskforce has provided the AMA, colleges, associations and societies with only a few months to respond, whilst the Taskforce has deliberated on the review over the last three years. Furthermore, the reports are not publicly available – rather they are sent in a targeted fashion to certain stakeholders. The AMA has pushed back on this and called for them to be posted publicly online.

Obviously, this expediated consultation timeframe presents risks for having the ability to interrogate the clinical appropriateness of proposed changes for the profession, and increases potential for unintended consequences to go unremarked. The AMA has raised these issues with the Minister’s office and the Department to call for timeframes to be pushed out, as is reasonably practical, to ensure the profession are appropriately and adequately consulted on the recommendations.

Surgical assistants

In September, the AMA worked extensively behind the scenes with the Medical Surgical Assistants Society of Australia (MSASA), the Royal Australasian College Of Surgeons (RACS), individual surgical assistants (AMA members and non-members) and AMA Council members to tease out the key issues and lodge a submission strongly opposing the MBS Review Taskforce’s proposed changes to remuneration arrangements for surgical assistants. The AMA was also responsible for ensuring other groups were aware of the submission process.

A number of AMA communications and medical media was generated around the proposed changes and AMA’s response. This included AMA ‘Rounds’ and GP Network News, and in the medical press and social media.

The following key issues formed the basis of the AMA submission:

that surgical assistants are independent practitioners and they should remain so;
negative impact on surgical training;
risk of de-skilling GPs in rural and remote areas;
proposed derived fee – baseless assumptions;
Private Health Insurance and Out of Pockets Reforms already underway;
there are alternative mechanisms to address Taskforce’s concerns; and
no data provided on the problem.

MBS Review Clinical Committee reports – Gynaecology, Breast Imaging, Nuclear Medicine

The AMA has also lodged a submission to the Department of Health on the MBS Reviews on gynaecology, breast imaging and nuclear medicine.

The main issues raised in the submission related to the gynaecology review and the following were discussed:

Inadequate profession engagement;
Time based item descriptors – perverse incentive and unintended consequences;
Additional auditing provisions – onerous and unnecessary;
Item restructure – simplification and streamlining are required; and
Recommendation 19, Item Number 35750 – disagree with recommendations.

In this submission, the AMA also provided broad observations on the MBS Review including concerns regarding operation of committees, as well as inadequate communication and consultation and the removal of the reports from the public website.

MBS Review Clinical Committee reports – Anaesthesia and maximum 3 item rule for surgical items

The AMA recently wrote to the Chair of the MBS Review Taskforce (Prof Bruce Robinson) supporting the Australian Society of Anaesthetists (ASA) opposition to the majority of the MBS Review anaesthesia clinical committee (ACC) recommendations. In the same letter the AMA also raised concerns regarding the maximum three item rule for Group T8 surgical items.

The AMA urged the MBS Taskforce and Government to work with the ASA to come to mutually agreeable changes to the anaesthesia items in the MBS that align with contemporary clinical evidence and practice and improve health outcomes for patients.

The AMA also communicated to Prof Robinson that it is deeply concerned that whilst on the one hand the PRC deferred its decision regarding the three-item rule, due to consultation feedback, but on the other hand this recommendation is taken forward and applied in a specialty clinical committee report (eg urology) without reference to any previous profession feedback on the recommendation.

The AMA sought Prof Robinson’s assurances that the three-item rule is open for further discussions and that the MBS Taskforce will coordinate with the affected Colleges, Associations, and Societies to come to mutually agreeable changes; that is consistent, as much as is reasonable, across the specialties; that align with contemporary clinical evidence and practice and improve health outcomes for patients.

AMA MBS Review Webpage

Finally, the AMA ‘s own MBS Review webpage is now live and provides AMA members (and the public) with a one-stop bulletin board on AMA’s engagement and advocacy with the MBS Reviews. I encourage you to visit the website for further information and future updates on AMA’s advocacy work on MBS Reviews. There you will also find all of the AMA’s submissions to date to the MBS Reviews, and advice on what we are currently working on. Furthermore, it provides the contact details so that those members who are interested in helping the AMA formulate its response to reviews can have their voices heard.

Only by members being engaged can the AMA hope to have a positive influence the direction, and outcomes, of the MBS Reviews.

Let’s be clear eyed while moving forward on private health insurance

BY ASSOCIATE PROFESSOR JULIAN RAIT, CHAIR, COUNCIL OF PRIVATE SPECIALIST PRACTICE

On October 11, Health Minister Greg Hunt announced the final rules that support the new private health insurance clinical categories and the Gold, Silver, Bronze and Basic classification system.

CPSP and the AMA have called on these reforms to deliver simplified, better value private health insurance products for consumers. A system that offers more comprehensive coverage, with clear definitions, and less caveats and carve outs. Will the new system deliver total clarity and transparency? Not quite, but it is going to be a lot simpler for consumers than trying to navigate through the current 70,000 policy offerings.

The AMA has always supported, two key aspects of these reforms:

Clarity about what medical conditions are covered in each tier of benefits; and
The use of standard clinical categories across all private health policies.

The new classification system categorises existing policies into easier to understand tiers. These tiers, in combination with new Private Health Information Statement (which includes mandatory information about what each policy covers), should make it easier for people to compare policies, to shop around and actually see what they are covered for.

This should enable consumers to know that when they book in for a procedure they are covered now and not have to wait an additional 12 months or try the public system.

The tiers outline minimum requirements, but they still allow insurers to add additional cover. The legislation clarifies that insurers can move people onto new products, closing old products, but introduces new protections about warning and information for consumers. Additionally, the Minister is on the record stating that “importantly consumers will not be forced to change their policy cover if they are happy with it”.

There are also some more hidden benefits that will come in with the new system.

That the system provides full mandatory cover for the medical conditions in each tier; partial cover is not permitted (except in Basic cover and for Psychiatry, Rehabilitation, and Palliative Care – except in Gold cover where there are no exclusions allowed at all);
The inclusion of gynaecology, breast surgery, cancer treatment, and breast reconstruction in bronze tier products;
That a clinical category covers the entire episode of hospital care for the investigation or treatment;
That an episode of hospital treatment covers the miscellaneous services allied to the primary service; and
Patients with limited cover for psychiatric care can upgrade their cover (once) to access higher benefits for in-hospital treatment without serving a waiting period.

While these look obvious, they haven’t always been included in policies. From next year they will be.

The Minister has called for an April 1, 2019 commencement to coincide with the annual announcement of new premiums. However, as with most major changes, not all groups can adapt as quickly as others. So, while the reforms start next year, insurers have a further 12 months to ensure that each of their products is compliant and to move people onto new products if required. This is not ideal, but the transition for the smaller insurers is likely to be very resource intensive. The Minister has stated that his expectation is that the great majority of policies will be ready to go by April 1 next year. He has also stated that these reforms will have an overall neutral to -0.3 per cent impact on premiums compared with current policy settings.

But we also need to be clear eyed here. This will not solve the wider issue of how to bridge the ongoing premium increases in the 4-5 per cent range, and wages growth at 2 per cent range. That fundamental paradox to a long-term, sustainable private health insurance system remains. These reforms will not address the concerns around private health insurer behavior, nor will they address the variation in rebates. These reforms are about making life a little easier for our patients, and our practices. But the AMA will need the support of all our members going forward – for clearly, the bigger problem is yet to be addressed.

Brain cooling after injury not worth the risks

Cooling the brain and body soon after a severe traumatic brain injury does not improve patient outcomes as previously thought, and exposes patients to unnecessary harm, a landmark Australian trial has found.

The technique – using a combination of cold intravenous fluids and surface cooling wraps, followed by slow re-warming – has been shown to be neuroprotective in animal studies, and is used in selected patients with severe traumatic brain injury (TBI) in most Australian intensive care units.

The theory is that hypothermia limits secondary brain injury by attenuating inflammation and biochemical cascades set off by trauma.

However limited clinical trial evidence to date has failed to demonstrate that the potential benefits of hypothermia outweigh the known increased risks of bleeding, infection, decreased heart rate and blood pressure and pneumonia.

Now a major study led by researchers from Monash University in Melbourne has been credited with providing definitive evidence that the technique has no impact on patients’ long-term outcomes.

The brain cooling study

Led by Professor Jamie Cooper, director of the Australian and New Zealand Intensive Care Research Centre, the POLAR study randomized 500 traumatic brain injury patients recruited from emergency departments and ambulance services in six countries to either prophylactic hypothermia or normothermia. All other care was at the discretion of the treating physician.

Whereas a previous study (Eurotherm) only used hypothermia in patients with evidence of brain swelling, patients in the POLAR trial were randomised to hypothermia regardless of intracranial pressure. This was in order to ensure hypothermia commenced as soon as possible after injury, to maximise the likelihood of benefit.

The targeted temperature in the hypothermia group was 33-35⁰C for at least 72 hours and up to 7 days. For patients in the normothermia group, the targeted temperature was 37⁰C, with surface-cooling wraps used when required.

At six months follow-up, the study found no benefit to patients receiving hypothermia, as measured by their capacity to live independently. In both groups, 49% of patients had a favourable Glasgow Outcome Scale Extended Score.

Furthermore, hypothermia did not improve secondary outcomes including mortality.

The intervention was, however, associated with increased rates of pneumonia (55% vs 51.3%) and intracranial bleeding (18.1% vs 15.4%), the authors reported in JAMA.

Professor Cooper told doctorportal: “My view is that we should now cease using hypothermia for TBI patients in Australia”.

“From now on, patients should not have to endure the risks of hypothermia because we know there are no benefits.”

Why no effect?

The latest study showed it takes much longer to reach the target temperature in clinical practice than it does in lab rats – even when hypothermia management commences as early as possible. It took 2.5 hours on average to reach the initial target temperature of 35⁰C, and 10 hours to reach the final target temperature of 33⁰C.

The authors said the delay was largely due to the time required to exclude risk factors for bleeding, such as ruptured spleen or persistent hypotension, that would contraindicate hypothermia.

An accompanying editorial by doctors from the University of Edinburgh suggested this time lag might explain why hypothermia “failed in translation from the bench to the bedside”.

The editorialists agreed that the weight of evidence was now firmly against hypothermia initiation during the acute phases of TBI management.

Is there ever a place for hypothermia in TBI?

Professor Cooper said it’s time for an explicit warning that hypothermia has no place in the management of TBI, even when there is significant intracranial pressure.

Current guidelines by the Brain Trauma Foundation only recommend against short-term prophylactic hypothermia for diffuse TBI, and are silent on other indications.

Professor Cooper said there was now clear evidence that if intensive management of intracranial pressure was required, barbiturates were the standard of care – not hypothermia or decompressive craniectomy. In a 2011 study in the New England Journal of Medicine, Professor Cooper’s team found decompressive craniectomy was linked with poorer outcomes compared with standard care.

Professor Stephen Bernard, medical director of Ambulance Victoria told doctorportal: “I think the POLAR trial did in fact provide a definitive answer that there is no benefit in the provision of early, prophylactic therapeutic hypothermia in patients with isolated severe traumatic brain injury.”

He continued: “I understand that there is still some enthusiasm for hypothermia as a last resort for the management of intracranial hypertension after thiopentone infusion, but these patients have a dreadful outcome so it is uncertain whether this will ever be tested in a clinical trial.”

Professor Cooper said the study’s findings were far from expected.

“Few of the authors anticipated that such extensive hypothermia would have such little evidence of any measurable effect at all, other than the known complications,” he said.

[Correspondence] Essential need for quality in surgical health-care systems

We congratulate Donald Berwick and colleagues (July 21, p 194)1 for highlighting the need for health systems to achieve safe, effective, universal health-care coverage in the Era of Sustainable Development. The need is most apparent in surgery, obstetrics, and anaesthesia, in which adverse health-care events can have devastating consequences. Surgery can be deemed a reliable stress test for health-care facilities and indicative of overall quality as it requires the successful integration of multiple systems.

[Articles] Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data

The perivascular FAI enhances cardiac risk prediction and restratification over and above current state-of-the-art assessment in coronary CTA by providing a quantitative measure of coronary inflammation. High perivascular FAI values (cutoff ≥–70·1 HU) are an indicator of increased cardiac mortality and, therefore, could guide early targeted primary prevention and intensive secondary prevention in patients.

Majority of intravenous catheters go in suboptimal site: research

International research has uncovered major inconsistencies in the way intravenous catheters are used, prompting calls to improve training and standards.

The Australian led study showed that 10% of peripheral intravenous catheters (PIVCs) were painful to the patient or otherwise symptomatic of phlebitis, and another 10% had signs of PIVC malfunction.

Over one-third of PIVCs had no documented daily assessment, and 21% of the dressings were suboptimal. The researchers found that two-thirds of all devices were placed in non-recommended sites, such as the hand, wrist, or antecubital veins.

The study, published in the Journal of Hospital Medicine, was based on an assessment of 40,620 PIVCs across 51 countries. The PIVCs were used primarily for intravenous medication and predominantly inserted in general wards.

Poor catheter practice can have serious consequences

Lead researcher Dr Evan Alexandrou, senior lecturer at Western Sydney University’s School of Nursing and Midwifery and Clinical Nurse Consultant at Liverpool Hospital, told doctorportal that he was not surprised by the results of the study. “There is a lot of literature out there on failure rates with PIVCs – up to 90% fail within a couple of days.”

“What we wanted to do was to look at what was happening at the coalface related to these devices.”

“The unfortunate thing is that the PIVC is seen as the default device and it may not be the most appropriate device to use.”

Failure rates can have significant implications for the patient, such as missed or delayed medication administration, as well as multiple cannulation attempts if they have poor venous access – which can cause pain and anxiety.

If serious enough, poor PIVC practice can lead to catheter-associated bloodstream infection, which is known to increase morbidity and mortality, Dr Alexandrou said.

Call for a national response

Dr Alexandrou said that “I think we need a national response – we need better training at an undergraduate and postgraduate level”.

This would mean an end to the 2 to 4-hour workshops on how to stick a patient. “This is antiquated teaching, and obviously not working when we look at the problems with PIVCs and failure rates with central venous access devices also.”

“We need a national clinical standard from the Australian Commission on Safety and Quality in Health Care, similar to ones we already have on procedure matching and infection prevention so that hospitals are compelled to look at the issue more seriously.”

Dr Alexandrou cited the Difficult Venous Access Pathway which he and a team developed at Liverpool Hospital in Sydney.

“We reduced cannulation attempts significantly by training nurses in ultrasound guided PIVC insertion – the average number of attempts with ultrasound is 1 compared to at least 4 without ultrasound.”

The benefits of improving catheter practice

Dr Alexandrou said there will be significant benefits if we do take steps to improve PIVC practice.

”It can improve the patient experience through the health system, ensure intravenous therapy is administered as prescribed, and potentially reduce hospital length of stay.”

He said that the average cost of a PIVC insertion, as costed by a health economist, is up to $69.

“Reducing failure and unnecessary cannulations can save the health system millions of dollars when you consider some 12 million devices are placed in Australia annually.”