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Observational Study
. 2014 Feb 23;18(1):R36.
doi: 10.1186/cc13741.

Residents learning ultrasound-guided catheterization are not sufficiently skilled to use landmarks

Julien Maizel, Laurianne Guyomarc'h, Pierre Henon, Santhi Samy Modeliar, Bertrand de Cagny, Gabriel Choukroun, Michel Slama
Observational Study

Residents learning ultrasound-guided catheterization are not sufficiently skilled to use landmarks

Julien Maizel et al. Crit Care. .

Abstract

Introduction: Ultrasound-guided (UG) technique is the recommended procedure for central venous catheterization (CVC). However, as ultrasound may not be available in emergency situations, guidelines also propose that physicians remain skilled in landmark (LM) placement. We conducted this prospective observational study to determine the learning curve of the LM technique in residents only learning the UG technique.

Methods: During the first three months of their rotation in our ICU, residents inexperienced in CVC used only the real-time UG technique. During the following three months, residents were allowed to place CVC by means of the LM technique when authorized by the attending physician.

Results: A total of 172 procedures (84 UG and 88 LM) were performed by the inexperienced residents during the study. The success rate was lower (72% versus 84%; P = 0.05) and the complication rate was higher (22% versus 10%; P = 0.04) for LM compared to UG procedures. Comparison between the five last UG procedures and the first five LM procedures performed demonstrated that the transition between the two techniques was associated with a marked decrease of the success rate (65% versus 93%; P = 0.01) and an increase of the complication rate (33% versus 8%; P = 0.01). After 10 LM procedures, residents achieved a success rate and a complication rate of 81% and 6%, respectively.

Conclusions: Residents who only learn the UG technique will not be immediately able to perform the LM technique, but require specific training based on at least 10 LM procedures. The question of whether or not the LM technique should still be taught when an ultrasound device is not available must therefore be addressed.

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Figures

Figure 1
Figure 1
Time course of the success rate and complication rate according to the number of procedures performed by each resident. (A) Success rate; (B) complication rate. Results are presented as mean and standard error of the mean (SEM).
Figure 2
Figure 2
Time course of venous return time and procedure time according to the number of procedures performed by each resident. (A) Venous return time; (B) procedure time. Results are presented as mean and standard error of the mean (SEM).
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References

    1. Troianos CA, Hartman GS, Glas KE, Skubas NJ, Eberhardt RT, Walker JD, Reeves ST. Councils on Intraoperative Echocardiography and Vascular Ultrasound of the American Society of Echocardiography: Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2011;24:1291–1318. doi: 10.1016/j.echo.2011.09.021. - DOI - PubMed
    1. Rupp SM, Apfelbaum JL, Blitt C, Caplan RA, Connis RT, Domino KB, Fleisher LA, Grant S, Mark JB, Morray JP, Nickinovich DG, Tung A. Practice guidelines for central venous access: a report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology. 2012;116:539–573. doi: 10.1097/ALN.0b013e31823c9569. - DOI - PubMed
    1. National Institute for Clinical Excellence. NICE Technology Appraisal No 49: guidance on the Use of Ultrasound Locating Devices for Placing Central Venous Catheters. [ http://www.nice.org.uk/nicemedia/live/11474/32461/32461.pdf]
    1. Monnet X, Lefrant JY, Teboul JL. Field 6. Safety practices for haemodynamic procedures (administration of vasoactive drugs, vascular and cardiac catheterization). French-speaking Society of Intensive Care. French Society of Anesthesia and Resuscitation. Ann Fr Anesth Reanim. 2008;27:e91–e99. doi: 10.1016/j.annfar.2008.09.012. - DOI - PubMed
    1. Lamperti M, Bodenham AR, Pittiruti M, Blaivas M, Augoustides JG, Elbarbary M, Pirotte T, Karakitsos D, Ledonne J, Doniger S, Scoppettuolo G, Feller-Kopman D, Schummer W, Biffi R, Desruennes E, Melniker LA, Verghese ST. International evidence-based recommendations on ultrasound-guided vascular access. Intensive Care Med. 2012;38:1105–1117. doi: 10.1007/s00134-012-2597-x. - DOI - PubMed

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