Success of Bristol centre inspires new way of treating patients across England

A close-up of a nurse's hands demonstrating ultrasound guided canulation A Bristol centre has been used as a blueprint for the rollout of a service that will see fewer patients need to go into surgery, reduce the time patients spend in hospital, improve patient safety and experience and save the NHS money.

NHS Blood and Transplant (NHSBT)’s Therapeutic Apheresis Services (TAS) unit, housed in the Bristol Haematology and Oncology Centre, used ultrasound guided canulation so successfully that the system was rolled out among the eight other TAS units across England, to help patients with a number of illnesses including sickle cell disease and blood cancers.

In an eight-month period, ultrasound guided canulation was used 177 times for 57 different patients or donors within the Bristol TAS unit. All of the canulations were successful and 96 central lines were avoided, saving the NHS approximately £43,000.

This success inspired the rollout of an ultrasound guided canulation training programme across the eight other TAS units across the country. It is thought over 200 central lines have been avoided since the training began in May 2023.

In addition, patients save up to half a day of time spent in hospital on every visit and avoid needing to go into theatre for line insertion and removals.

In ultrasound guided canulation, a nurse will use an ultrasound machine to find a vein which cannot normally be found. The nurse is then able to see the cannula being placed into the vein in real-time, avoiding the need for multiple attempts at canulation and reducing discomfort for patients.

A TAS nurse using ultrasound to canulate Tegan Rendell ahead of her plasma exchange Ultrasound guided canulation – and the incredible nurses who do it – make my experience so much better.

Tegan Rendell, 20, attends Bristol’s Therapeutic Apheresis Services every eight weeks, for a plasma exchange to treat Autoimmune Limbic Encephalitis, an autoimmune disease that attacks her brain.

She says: "My illness means I need to undergo a lot of medical procedures and it can be really traumatic as my veins are so difficult to find.

"But ultrasound guided canulation – and the incredible nurses who do it – make my experience so much better than it might otherwise be. The canulation is quick and easy and I don’t spend the whole eight weeks dreading the next appointment."

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Teresa Baines, Head of TAS at NHSBT

Teresa Baines, Head of Therapeutic Apheresis Services at NHS Blood and Transplant, says:

“Ultrasound guided canulation is a complex, technical skill and we’re proud to have rolled it out, via a programme of training across all nine of our units. The benefits to the patient are profound and the feedback from them has been extremely positive.

“A lot of our patients come to us for regular treatments and so to be able to avoid multiple attempts at canulation or being taken to surgery for line insertion (and later removal) on every visit, makes a huge difference to the quality of their care. They’re reporting feeling much more comfortable, spending less time in hospital and generally having less dread around upcoming procedures and that is all that we can ask for.

“Bristol is one of our busiest units and yet had the lowest rate of central line insertions thanks to this method and so we knew that theirs was a formula we wanted to roll out across the whole of TAS. We’re so grateful to everybody involved in making it such a success and we look forward to continuing to train and develop our teams to ensure our patients are the most comfortable they can be when with they’re with us.”

Sam Ntakirutimana, Education and Training Lead Nurse at TAS

Sam Ntakirutimana, Education and Training Lead Nurse at TAS, who routinely uses ultrasound guided canulation in patient care and rolled out the training to all nine units, says:

“Rolling out this training throughout all of our units has made a huge difference for our patients. Though our teams are highly skilled in cannulation, there are occasions where you cannot see or feel a vein, meaning a patient would need to have a central line inserted.

"Using the ultrasound to find veins that are sometimes even just a few millimetres below the skin ensures that our patients have a better overall experience – the feedback from them has been fantastic and as their care team, that’s delightful to hear.

“Ultrasound guided cannulation is something that our Bristol team is highly skilled in and has been using with great success, so it was only right that we expanded the service throughout all of our sites.

"It took one year of intensive training, but we are proud to say that every one of our units now has at least one team member who can use the ultrasound to cannulate when veins are harder to find and that this has led to a huge reduction in the number of patients needing to have a central line fitted.

“Our aim now is to get every TAS nurse trained up in the skill, to continue to improve patient experience, reduce numbers of central lines being fitted and save the NHS money.”

Ultrasound guided canulation is now being used at all nine TAS units across England. The roll out will continue with an ambition to train all NHSBT TAS nurses over the coming year.

Find out more about NHSBT's Therapeutic Apheresis Services.