Safe design of medical equipment: Employing usability heuristics to examine the issue of guidewire retention after surgery

Background: Central Venous Catheterisation (CVC) is a medical procedure that has been linked with cases of retained guidewires in a patient after surgery. Whilst this is theoretically a completely avoidable complication, a guidewire of up to 60cm being retained in a patient's vascular system poses a major risk. In recently reported cases, guidewires retained inside patients have not been detected for several years. Aims: The ultimate aim was to develop appropriate, operator-centred safe design solutions that reduce guidewire retention errors. Method: This paper focuses specifically on the application of Nielsen's ten usability heuristics 1 to the issue of retained guidewires. Following the development of a task analysis of the procedure, three researchers (from medical, safety and human factors backgrounds) independently applied the usability heuristics, then met to analyse the findings. Results: A range of usability problems were identified in the Central Venous Catheterisation procedure, and solutions to the identified issues were then proposed: These focused on the design of equipment, or the wider guidewire insertion procedure. The paper details the identified usability problems and possible redesign solutions from the 10 usability heuristics. Conclusion: Overall, the application of the usability heuristics was found to be a useful method both to explore medical device interface problems and to generate possible countermeasures. Further work to eliminate/engineer out the possibility of guidewires being retained is briefly reported.