Effects of practitioner’s experience on the clinical performance of ultrasound-guided central venous catheterization: a randomized trial

Abstract

We investigated whether two needle insertion techniques for ultrasound-guided internal jugular vein (IJV) catheterization differ in the number of needling attempts and complication rate between inexperienced and experienced practitioners. A total of 308 patients requiring IJV catheterization were randomly assigned into one of four groups: IJV catheterization performed by inexperienced practitioners using either Seldinger (IE-S; n = 78) or modified Seldinger technique (IE-MS; n = 76) or IJV catheterization performed by experienced practitioners using either Seldinger (E-S; n = 78) or modified Seldinger technique (E-MS; n = 76). All catheterizations were performed under the real-time ultrasound guidance. The number of needling attempts was not significantly different between the two techniques within each experience group (between IE-S vs. IE-MS P = 0.550, between E-S and E-MS P = 0.834). Time to successful catheterization was significantly shorter in the E-S group compared to E-MS group (P < 0.001) while no significant difference between IE-S and IE-MS groups (P = 0.226). Complication rate was not significantly different between the two techniques within each experience group. Practitioner’s experience did not significantly affect the clinical performance of needle insertion techniques during ultrasound-guided IJV catheterization except the time to successful catheterization. Regarding the number of needling attempts and complication rate, both techniques could be equally recommended regardless of practitioner’s experience.Trial registration: clinicaltrials.gov (https://clinicaltrials.gov/ct2/show/NCT03077802).

Impact of Ultrasound Guidance During Placement of Tunnel Dialysis Catheter

“…16 Operator experience, ultrasound guidance, and regular training courses have been identified as crucial factors in minimizing complication rates. 10,17,18 Our research did not document instances of arterial catheterization, cardiac tamponade, pneumothorax, hemothorax, air embolism, cardiac arrhythmias, guidewire embolism, catheter breakage, neurologic injury, or hemorrhage. However, due to loss to long-term follow-up, data on long-term complications such as infection rates, venous thrombosis, and central venous stenosis were unavailable, thus hindering their assessment.…”

“…Successful CVC placement is largely dependent on the experience of the doctor doing the procedure; this also applies to TCC placement. 10 Doppler vascular ultrasound (US) is increasingly utilized to mitigate complications associated with central venous catheter (CVC) insertion and enhance the safety and precision of the procedure. Conventionally, CVC placement relies on landmark techniques, which involve identifying anatomical structures and palpating arteries adjacent to the veins.…”

Application of plan-do-check-act management to improve first-attempt insertion success rates of internal jugular vein catheterization for standardized training residents in an intensive care unit

“…Thus, it is very important to follow the classical approach for puncture. Furthermore, even if guided by ultrasound, the complications related to catheterization by unskilled operators are much higher than those related to catheterization by skilled operators [ 12 ]. Failure to follow the procedures may result in serious adverse consequences.…”

Complications of central venous catheterization at a vascular surgery service in a teaching hospital: a prospective cohort study

“…As principais variáveis coletadas estão citadas na Tabela 1 . O nível de experiência do executor do acesso foi dicotomizado em maior ou igual e menor de 50 acessos venosos centrais inseridos com sucesso em toda a carreira acadêmico-profissional, em conformidade com estudos prévios 7 , 10 , 11 . Variáveis do paciente correlacionadas com maior necessidade de punções da pele por tentativa de acesso e maior incidência de complicações mecânicas, conhecidas como “critérios de dificuldade” na literatura 12 - 15 , também foram sistematicamente procuradas antes de cada tentativa, conforme descrito na Tabela 2 .…”