Updated local safety standards for invasive procedures: Guidance or suggestions?

Dear Sir,

We congratulate Windsor et al. ¹ on their update to the Local Safety Standards for Invasive Procedures (LocSSIPs) for central venous catheter insertion and other procedures. Efforts to improve patient safety are laudable, and standardisation of proven safety interventions is highly desirable. However, in their brief published article the authors have not provided a detailed rationale for many of the changes they have made. The authors allude to the revisions being required in order to “encompass evolving evidence” and as a response to “reported safety incidents” and yet do not cite any relevant research or any incident reports which have been published.^2,3 With regard to central venous catheter insertion, the authors have introduced a new requirement for placement confirmation using two methods out of: pressure transduction, ultrasound (details not described) and paired blood gases. There is no elaboration on this new idea nor of the pitfalls of each method. Our group recently published the largest study to date of inadvertent arterial trauma due to central venous catheter insertion ⁴ which discusses the limitations of various confirmatory methods. We also found that stroke and death can occur despite immediate recognition of arterial cannulation, suggesting that preventing arterial dilatation is the key step to avoid permanent harm from this particular complication. We would welcome national guidance or example checklists which specifically address this, for example by incorporating a two-person check of guidewire position, or pre-dilatation transduction.

It may be that these updated LocSSIPs are based primarily on the authors’ own opinions and the contents intended only as a suggestion; if so, we would encourage transparency in this regard, otherwise they may be inappropriately used as a standard against which practice is judged. If, however, they are intended as clinical guidance, we would welcome a fuller justification of the basis for these changes, which will no doubt enhance their adoption.

Yours faithfully,

Peter W. Hart Department of Anaesthesia, Bradford Teaching Hospitals Foundation Trust, UK Penelope Beddoes Department of Anaesthesia, Bradford Teaching Hospitals Foundation Trust, UK David Burtle Department of Anaesthesia, Bradford Teaching Hospitals Foundation Trust, UK Michelle L. Bradshaw Department of Anaesthesia, Bradford Teaching Hospitals Foundation Trust, UK