Intravenous therapy is an essential part of clinical care used in a wide variety of healthcare settings. Thus, intravenous catheters have become indispensable to clinical practice. However, catheter related infections are a major source of morbidity and mortality with rates as high as 10% to 20%. Current guidance recommends a number of strategies to reduce the incidence of catheter-related infections. These include skin preparation, avoiding glove contamination when handling and inserting catheters and the choice of material used.

Strategies to prevent infection need to change and develop to reflect the advances in technology and delivery of healthcare.

Pre-operative assessment (POA) has been advocated for use to achieve a number of goals including reducing cancelled operations on the day of surgery, and therefore waiting lists. POA has historically been provided by junior doctors, but the change in focus of their role in addition to the new roles being taken on by nurses has led to nurse-led POA. The aim of this review was to determine whether nurse-led POA reduces the cancellation rate of elective surgical in-patient procedures. The Cochrane Library, Medline, Cinahl and Embase databases were searched for systematic reviews, randomised control trials and cohort studies examining nurse-led POA. After applying inclusion criteria only four cohort studies were deemed to be suitable to be critically appraised. One study had no cancellations in either the doctor or nurse-led POA groups. Another study had low cancellation rates in the nurse-led POA group, but the control group was not suitably defined for adequate verification as to whether the cancellation rates were lower because they had been pre-assessed. The final two studies revealed similar absolute risk reductions, number needed to treat and odds ratios. In summary nurse-led POA appears to reduce cancellation rates on admission, but the evidence for this is relatively weak, primarily because study samples have been small. Further trials are needed which have samples that are sufficient to detect a true difference between the intervention and control group if one exists.

Post operative nausea and vomiting remains one of the most common complications following surgery. Its high incidence, despite better anti-emetic medication, requires a better understanding of its mechanism and management in order to improve the patient experience. This article reports on a recent audit carried out in a dedicated post anaesthetic orthopaedic unit to assess the level of the problem.

I was invited to write this article after I gave a talk about setting up a preoperative assessment clinic. If you're facing the daunting task of providing a new service in your primary or secondary care job I hope that you'll find something useful here. Before I begin I'll repeat the confession that I made when I gave my talk. I am not an expert. In fact I have had little experience setting up new clinics. What I have done here is distil the experience of colleagues from around the country with whom I have had the pleasure of talking. These are their words.

This paper discusses the role, responsibilities and practices of anaesthetic practitioners in the Netherlands in relation to their counterparts in the United Kingdom (UK), these practitioners representing an important yet overlooked section of the health care workforce. This takes place in the context of the UK National Health Service (NHS) modernisation agenda and the European Commission's (EC) aim to enhance the mobility of health care staff throughout the European Union (EU) through standardisation of variations in qualifications, skill levels, methods and working practices (Bologna, 1999; Lisbon Strategy, 2000; EHTAN, 2005).

It is clear that significant disparities remain between anaesthetic practitioners in both countries and that we need to explore ways of arriving at compatibility between the different grades. However, this does not currently appear to be happening at EU level. Despite the huge responsibilities on these practitioners, this sector of the EU health care workforce remains largely invisible and there appears to be no concerted attempt at EU level to develop appropriate competencies for them. Further research is required into this area, including: evaluative studies of policies for service redesign and new roles, professional regulation and the impact on outcomes for health service users.

Background: Postoperative hypothermia is stressful and elevates blood pressure and heart rate. This study evaluated the effects of warming IV fluids on the perioperative hemodynamic situation.

Methods: Perioperative hemodynamic parameters were measured in 60 patients undergoing orthopaedic surgery. Patients were divided into two groups according to the temperature of intraoperative IV fluids.

Results: Core and skin temperature of the two groups decreased during surgery but reduced more in the hypothermic group (p < 0.005). Postoperative mean arterial blood pressure increased more in the hypothermic group versus normothermic group (p < 0.005). Shivering was observed in 21 of 30 hypothermic and 11 of 30 normothermic group (p < 0.005) and recovery time was lower in normothermic group (36 ± 5 vs. 26 ± 3 min, p < 0.005).

Conclusion: Warming of intraoperative IV fluids reduces perioperative changes in hemodynamic parameters.

Objective: To investigate the completeness of documentation of anaesthetic charts in elective orthopaedic anaesthesia.

Design: Data collection from medical records.

Setting: Orthopaedic department, teaching hospital.

Participants: Anonymous anaesthetic consultants participating in orthopaedic surgery.

Intervention: E-mail and verbal message regarding 2nd data collection to anaesthetic colleagues.

Main outcome measures: Documentation of data of variables on anaesthetic chart.

Results: Good documentation of most variables. An average improvement of 5.7% in data documentation, range of −2.7% to 24.7%. Poor documentation of blood loss and urinary output.

Conclusions: The importance of the anaesthetic chart cannot be underestimated. A close working relationship with ones colleagues in anaesthesia promotes a fuller use of the chart and contributes to its continued development as a source of information.