Guidewire retention following central venous catheterisation: a human factors and safe design investigation.

BACKGROUND: Central Venous Catheterisation (CVC) has occasionally been associated with cases of retained guidewires in patients after surgery. In theory, this is a completely avoidable complication; however, as with any human procedure, operator error leading to guidewires being occasionally retained cannot be fully eliminated. OBJECTIVE: The work described here investigated the issue in an attempt to better understand it both from an operator and a systems perspective, and to ultimately recommend appropriate safe design solutions that reduce guidewire retention errors. METHODS: Nine distinct methods were used: observations of the procedure, a literature review, interviewing CVC end-users, task analysis construction, CVC procedural audits, two human reliability assessments, usability heuristics and a comprehensive solution survey with CVC end-users. RESULTS: The three solutions that operators rated most highly, in terms of both practicality and effectiveness, were: making trainees better aware of the potential guidewire complications and strongly emphasising guidewire removal in CVC training, actively checking that the guidewire is present in the waste tray for disposal, and standardising purchase of central line sets so that differences that may affect chances of guidewire loss is minimised. CONCLUSIONS: Further work to eliminate/engineer out the possibility of guidewires being retained is proposed.

Development of low-pH cements for immobilisation of intermediate level radioactive waste: Achievements and challenges

Although cementation is a widely recognized solidification/ stabilization process for immobilisation of Intermediate Level Radioactive Waste (ILRW), the low resistance to hyperalkaline pore waters compromises the effectiveness of the process when Portland Cement (PC) is employed. Moreover the manufacture of PC is responsible for significant CO2 emissions. In this context, low pH cements are environmentally more suitable and have emerged as a potential alternative for obtaining secure waste forms. This paper summarises the achievements on development of low-pH cements and the challenges of using these new materials for the ILRW immobilisation. The performance of waste forms is also discussed in terms of radionuclides release. Reactive magnesium oxide and magnesium phosphate cements are emphasised as they feature important advantages such as consumption of available constituents for controlling acid-base reactions, reduced permeability and higher density. Additionally, in order to identify new opportunities for study, the long-term modelling approach is also briefly discussed. Copyright © 2013 by ASME.