Tag Archives: study day

Supraclavicular nerve block

Searle or Chang approach

Chang: parallel to clavicle, in dip of neck. Look for pleura (fuzzy parallel lines) & rib (single echogenic line with acoustic shadow). AVOID PLEURA! Nerve plexus -> artery -> vein (brachiocephalic valve may be present)

Searle: parasagital (at approx 60 degrees to Changs) in dip of neck

Clinical tips:

  • Do for deepest targets first
  • Up to 30ml of mix (1:1 of 1% prilocaine + 0.25% bupivicaine)
  • Supplement with peripheral nerve blocks 5ml of 0.5% bupivicaine

 

Links:

http://www.jaypeejournals.com/eJournals/ShowText.aspx?ID=542&Type=FREE&TYP=TOP&IN=_eJournals/images/JPLOGO.gif&IID=53&isPDF=YES

http://www.cambridgeorthopaedics.com/cambridgeanaesthetics/advancednerveblocks/Supraclavicular%20block.htm

From Derby Upper Limb Regional Course & clinical training at RDH

Quality Improvement – what does that actually mean?

From the RCOA ‘QI and Patient Safety’ day one definition was:

a formal approach to analysis of performance and systematic efforts to improve it

Take home messages:

Set a clear aim

Map the process

identify the primary and secondary drivers (which are ideally evidence based)

Identify and collect data: primary outcome measures, proceess measures, balancing measures

frequent & low volume data collection -> run charts

frequent PDSA cycles/iterations

give feedback/charts to those on shop floor

When choosing a project align with departmental/trust/wider strategies

Engage people. MDT. give people ownership

Put yourself in their shoes and think ‘what is in it for them?’

Develop systems that will improve quality and that are sustainable

Principles:

make it easier to do the right/best thing. Change the system/processes.

Look at successes (internally and externally), not just failures.

Financial argument – safety often saves money e.g. cost of managing complications, litigation