Determination of the learning curve for ultrasound-guided jugular central venous catheter placement

Nguyen, Ba-Vinh; Prat, Gwénaël; Vincent, Jean‐Louis; Nowak, Emmanuel; Bizien, Nicolas; Tonnelier, Jean-Marie; Renault, Anne; Ould-Ahmed, Mehdi; Boles, Jean-Michel; L’Her, Erwan

doi:10.1007/s00134-013-3069-7

Cited by 64 publications

(49 citation statements)

References 14 publications

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“…9 With respect to skills such as USG CVC insertion there is, however, a paucity of evidence for the specific type and volume of simulator practice required to achieve technical proficiency. 2,10 Residency programs would benefit from evidence of this nature to guide the design of competency-based curricula, as it could inform such things as the number of practice sessions to schedule and the most effective forms of practice.…”

Section: Introductionmentioning

confidence: 99%

Development and Evaluation of a Simulation-based Curriculum for Ultrasound-guided Central Venous Catheterization

McGraw

Chaplin

McKaigney

et al. 2016

CJEM

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Objective: To develop a simulation-based curriculum for residents to learn ultrasound-guided (USG) central venous catheter (CVC) insertion, and to study the volume and type of practice that leads to technical proficiency. Methods: Ten post-graduate year two residents from the Departments of Emergency Medicine and Anesthesiology completed four training sessions of two hours each, at two week intervals, where they engaged in a structured program of deliberate practice of the fundamental skills of USG CVC insertion on a simulator. Progress during training was monitored using regular hand motion analysis (HMA) and performance benchmarks were determined by HMA of local experts. Blinded assessment of video recordings was done at the end of training to assess technical competence using a global rating scale. Results: None of the residents met any of the expert benchmarks at baseline. Over the course of training, the HMA metrics of the residents revealed steady and significant improvement in technical proficiency. By the end of the fourth session six of 10 residents had faster procedure times than the mean expert benchmark, and nine of 10 residents had more efficient left and right hand motions than the mean expert benchmarks. Nine residents achieved mean GRS scores rating them competent to perform independently. Conclusion: We successfully developed a simulation-based curriculum for residents learning the skills of USG CVC insertion. Our results suggest that engaging residents in three to four distributed sessions of deliberate practice of the fundamental skills of USG CVC insertion leads to steady and marked improvement in technical proficiency with individuals approaching or exceeding expert level benchmarks. RÉSUMÉObjectifs: L'étude visait à élaborer un programme de formation axé sur la simulation et conçu à l'intention des résidents en vue de l'apprentissage de la mise en place échoguidée de cathéters veineux centraux (CVC), et à déterminer le nombre et le type d'exercices pratiques permettant d'en arriver à la compétence technique. Méthode: Dix résidents, en deuxième année d'études de cycles supérieurs, en médecine d'urgence et en anesthésie ont participé à quatre séances de formation de deux heures chacune, tenues à deux semaines d'intervalle, dans le cadre d'un programme structuré de pratique intentionnelle sur simulateur, en vue de l'acquisition des compétences de base dans la mise en place échoguidée de CVC. Les progrès réalisés durant la formation ont été suivis de près à l'aide d'un outil régulier de mesure, l'Hand Motion Analysis (HMA), et les valeurs de référence ont été déterminées par l'HMA des experts locaux. À la fin des séances de formation, les compétences techniques enregistrées sur bande vidéo ont fait l'objet d'une évaluation à l'insu par des experts, sur une échelle globale de notation (EGN). Résultats: Au départ, aucun des résidents n'atteignait l'une ou l'autre des valeurs de référence. Au fil de la formation, les mesures de l'HMA des résidents ont révélé une amélioration constante et i...

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Section: Introductionmentioning

confidence: 99%

Development and Evaluation of a Simulation-based Curriculum for Ultrasound-guided Central Venous Catheterization

McGraw

Chaplin

McKaigney

et al. 2016

CJEM

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“…In adults and children, ultrasound‐guided central venous catheterization has a higher success rate than the landmark technique . Moreover, ultrasound‐guided vascular access skill can be acquired easily by novice trainee …”

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confidence: 99%

Ultrasound Versus Traditional Palpation to Guide Radial Artery Cannulation in Critically Ill Children: A Randomized Trial

Anantasit

Cheeptinnakorntaworn

Khositseth

et al. 2017

J of Ultrasound Medicine

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Objectives-To identify success rates for radial artery cannulation in a pediatric critical care unit using either palpation or ultrasound guidance to cannulate the radial artery.Methods-A prospective randomized comparative study of critically ill children who required invasive monitoring in a tertiary referral center was conducted. All patients were randomized by a stratified block of 4 to either ultrasound-guided or traditional palpation radial artery cannulation. The primary outcomes were the first attempt and total success rates.Results-Eighty-four children were enrolled, with 43 randomized to the palpation technique and 41 to the ultrasound-guided technique. Demographic data between the groups were not significantly different. The total success and first attempt rates for the ultrasound-guided group were significantly higher than those for the palpation group (success ratio, 2.03; 95% confidence interval, 1.13-3.64; P 5 .018; and success ratio, 4.18; 95% confidence interval, 1.57-11.14; P 5 .004, respectively). The median time to success for the ultrasound-guided group was significantly shorter than that for the palpation group (3.3 versus 10.4 minutes; P < .001). Cannulation complications were lower in the ultrasound-guided group than the palpation group (12.5% versus 53.3%; P < .001).Conclusions-The ultrasound-guided technique could improve the success rate and allow for faster cannulation of radial artery catheterization in critically ill children.

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“…showed that 41% of the programs have no minimum requirement for NTHDC placement . The argument for having a minimum number of procedure requirements is based on studies that show improvement in procedural skills with repeated line placement . However, it is unclear what the optimal number of NTHDC performed should be before someone can be certified to be “competent” as the learning curve for each individual is different.…”

Section: Acute Dialysis Access‐the General Nephrology Experiencementioning

confidence: 99%

“…6 The argument for having a minimum number of procedure requirements is based on studies that show improvement in procedural skills with repeated line placement. 16 However, it is unclear what the optimal number of NTHDC performed should be before someone can be certified to be "competent" as the learning curve for each individual is different. Moving towards a more competency-based system would be better where learners practice until they reach a predetermined achievement standard regardless of how many attempts it takes to get these results.…”

Section: Introductionmentioning

confidence: 99%

Dialysis access procedure training for the nephrologist

Waheed

Maursetter

Yevzlin

2018

Seminars in Dialysis

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Historically, the placement and maintenance of dialysis access has been an integral part of nephrology training. However, in recent years, a big debate has ensued regarding whether this should be limited to trainees' understanding and counseling the patients regarding indications, alternatives, risks and possible complications of these procedures or should it actually involve more of a hands-on experience for the trainees. Some of the barriers in making these procedures a requirement across the board are the lack of standardization of procedural training across various training programs and the absence of consensus on what achieving competency in these procedures looks like. However, in the era of declining interest in nephrology, giving up "ownership" of nephrology procedures and increasing reliance on other sub specialties might be a deterrent in attracting residents to this field; we have to make a concerted effort to increase the exposure and opportunities for the trainees to perform these procedures. Moreover, we need to emphasize the implementation of a curriculum for nephrology fellows to evaluate access properly in order to decrease the burden of access related complications. Lastly, we need to continue working towards a more structured curriculum for a dedicated interventional nephrology fellowship for trainees who want to focus on procedures for their long-term career goals.

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Determination of the learning curve for ultrasound-guided jugular central venous catheter placement

Abstract: Our study demonstrates that skills in US-guided CVC placement can easily be acquired with training.

Cited by 64 publications

References 14 publications

Development and Evaluation of a Simulation-based Curriculum for Ultrasound-guided Central Venous Catheterization

Development and Evaluation of a Simulation-based Curriculum for Ultrasound-guided Central Venous Catheterization

Ultrasound Versus Traditional Palpation to Guide Radial Artery Cannulation in Critically Ill Children: A Randomized Trial

Dialysis access procedure training for the nephrologist

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