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Clinical Communiqué Volume 3 Issue 2 June 2016

Download PDF:  Clinical Communiqué June 2016 Edition


In this edition


  • Editorial

  • Case #1 A LINE TOO LONG

  • Case #2 AN ELUSIVE BREACH

  • Case #3 NOT WHERE YOU THINK YOU ARE

  • Expert Commentary CENTRAL VENOUS ACCESS


Editorial


In this issue we are going to focus on the single theme of risks associated with central venous catheter insertions. A common procedure in complex patients with some recurring errors that should be amenable to system change.

First though, a chance to examine an example of real systemic change towards safer practice. You may recall the case we described in our last issue of the patient who died from complications that occurred following a liposuction procedure (Volume 3, Issue 1: Post-operative pain – When to worry). What we did not know at the time was that the Medical Board of Australia was about to issue guidelines on clinical practice for registered medical practitioners who perform cosmetic medical and surgical procedures.

The Board consulted widely with the medical profession, the industry and the community about the best way to protect consumers seeking cosmetic medical and surgical procedures. The new guidelines were published in May 2016 and will come into effect on the 1st October 2016 and apply to all medical practitioners, including specialist plastic surgeons, cosmetic surgeons and cosmetic physicians regardless of their qualifications. Among the key points are:

  • A seven-day cooling off period for all patients before major procedures,

  • For all persons under 18 years there is a three-month cooling off period before major procedures and a mandatory evaluation by a registered psychologist, general practitioner or psychiatrist,

  • The treating medical practitioner is to take explicit responsibility for post-operative patient care and for making sure there are emergency facilities when they are using sedation, anaesthesia or analgesia.


The guidelines also provide direction on the issues of patient assessment and informed consent, and communication about the risks and possible complications of cosmetic procedures. What is particularly encouraging is the role that clinical staff, health professional regulators, and medico-legal mortality reviews played in the development of these guidelines. In this issue, we present three cases where complications arose following central venous catheter insertion. One catheter migrated too far, another catheter went the wrong way, and the last caused damage to its adjacent structures. Each of these are recognised albeit uncommon complications of central venous catheters, yet the cases continue to illustrate the many difficulties in the recognition of catheter misplacement.

The Clinical Communiqué welcomes a new case author from Tasmania, Ms Libby Newman, who has over ten years’ experience working with the Coroners Court of Tasmania, and we are privileged to include an expert commentary from Professor David Story who is Professor and Chair of Anaesthesia at the The University of Melbourne.

Finally, we are thrilled to announce the launch of our new website in the near future. We hope you will enjoy navigating around the site and will continue to use and recommend the site to your colleagues. Please let us know if there is anything else you would like to see on our site, and we will continually endeavour to upgrade and improve our content for our readers.