IntroductionRadiation exposure from intra-operative fluoroscopy in orthopaedic trauma surgery is a common occupational hazard. References for fluoroscopy use in the operating room for commonly performed operations have not been reported adequately. This study aimed to report appropriate intra-operative fluoroscopy use in orthopaedic trauma and compare the effect of surgery type and surgeon grade on radiation exposure.MethodsData on 849 cases over an 18-month period were analysed retrospectively. Median and 75th centile values for dose area product (DAP), screening time (ST), and number of fluoroscopy images were calculated for procedures where n > 9 (n = 808).ResultsMedian DAP for dynamic hip screws for extracapsular femoral neck fractures was 668 mGy/cm2 (ST 36 s), 1040 mGy/cm2 (ST 49 s) for short proximal femoral nail, 1720 mGy/cm2 (ST 2 m 36 s) for long femoral nail for diaphyseal fractures, 25 mGy/cm2 (ST 25 s) for manipulation and Kirschner wire fixation in distal radius fractures, and 27 mGy/cm2 (ST 23 s) for volar locking plate fixation in distal radius fractures. These represented the five commonest procedures performed in the trauma operating room in our hospital. Experienced surgeons utilized less radiation in the operating room than junior surgeons (DAP 90.55 vs. 366.5 mGy/cm2, p = 0.001) and took fewer fluoroscopic images (49 vs. 66, p = 0.008) overall.ConclusionsThis study reports reference values for common trauma operations. These can be utilized by surgeons in the operating room to raise awareness and perform clinical audits of appropriate fluoroscopy use for orthopaedic trauma, using this study as guidance for standards. We demonstrated a significant reduction in fluoroscopy usage with increasing surgeon experience.

The majority of patients admitted to hospital will become a recipient of an intravenous cannula (IVC) during their inpatient admission. Numerous case reports have demonstrated adverse events and critical incidents as a result of accidental intraarterial (IA) cannulation, specifi cally in the antecubital fossa (ACF). ACF cannulation increases the risk of extravasation injury, phlebitis and accidental IA insertion. The Royal College of Nursing (RCN) and local trust guidelines recommend that insertion site should be chosen in the following order: hand, wrist, forearm, ACF veins. Sites over articulating joints should also be avoided. Therefore, the IV Therapy Group conducted a snapshot audit to assess all patients with IVC. The aim of this project was to identify and investigate the reasons for increased ACF cannulation after an assessment of vascular integrity, and to highlight the extent of this issue in choice of IVC siting. MethodsPatients with IVC in situ were reviewed on all inpatient wards at Colchester General Hospital (except EAU and A&E) using a pro forma. Data collection was performed by the IV Therapy Group on 2 May 2013. Data were collected from patients, medical notes, nursing records, medication charts, and then audited against trust guidelines for IVC insertion. ResultsIn the 161 patients that were reviewed, we demonstrated that position of IVC was distributed almost evenly between the hand (35%), forearm and wrist (38%), and ACF (27% -deemed signifi cantly high by the IV Therapy Group -of which only 30% had poor vascular integrity). Insertion details were not documented in 81% of cases. Training issues were identifi ed amongst all staff groups, and human factors in technique and beliefs were addressed. We established re-education for staff members who cannulate in the form of workshops at trust inductions. We designed a poster and screensaver for all inpatient wards and trust computers respectively -which included 'The 4-point check for IV cannulation' , trust guidelines, and a list of warning signs for accidental IA cannulationto raise awareness and implement a change in current IV cannulation technique. ConclusionsFor patient safety, we advocate against routine ACF cannulation, as it risks the potential for accidental IA insertion, and the subsequent harm caused by unintentional IA drug administration. This can be prevented by assessing vascular integrity, starting distally when attempting intravenous cannulation, and recognising when a cannula is unintentionally inserted into an artery.

Contaminated blood cultures cause a diagnostic and therapeutic challenge for microbiologists and physicians. There is potential risk to patients and expense to hospital trusts from inappropriate antibiotic administration and further tests. Data collection by the director of infection prevention and control (DIPC) found high contamination rates for blood culture sampling in the emergency department (ED) and emergency assessment unit (EAU). From August 2013 to January 2014, ED contamination rates were 6.7%, compared with an acceptable 2% for the medical and surgical wards. This project was undertaken to identify the factors causing this unprecedented increased contamination rate in the acute setting. The objective was to implement changes based on these fi ndings that would reduce contamination rates and thus increase diagnostic precision, save money and improve the accuracy of patient treatment.