Ultrasound-guided central venous catheter insertion: teaching and learning

Should Nephrology Training Programs Continue to Train Fellows in the Placement of Temporary Hemodialysis Catheters?

“…The use of simulation has been associated with improved patient outcomes in CVC placement as well as improved adherence to best practices in THDC placement . Simulation should include training in US guidance, as this has become standard of care for bedside placement of small‐bore CVC's ; randomized trials of US guidance in THDC placement have also shown clear benefit .…”

A case of femoral arteriovenous fistula caused by central venous catheterization under inadequate ultrasound guidance

“…When a central venous catheter is inserted with real-time ultrasound guidance (short axis view/outof-plane approach), the skin insertion point should be located right next to the probe, and the needle tip should be visualized at all times until the target vein is punctured. In 2014, several key attributes for teaching safe ultrasound-guided central venous catheter insertion were proposed as follows: (1) a curriculum clearly describing the technical approach and cognitive elements required, preferably with video-based procedural examples; (2) hands-on simulation training to develop hand-eye skills; (3) an emphasis on techniques that allow visualization of the needle tip at all times; and (4) insertions supervised by experienced clinicians giving feedback for improvement [4].…”

Training and Education

“…Approaches to training should be based on a curriculum that clearly defines the cognitive knowledge and technical skill required to undertake ultrasound-guided vascular access (Schmidt and Kory 2014;Troianos et al 2011). An international evidence-based consensus task force established through the World Congress of Vascular Access recommends 6-8 h of didactic education, 4 h hands-on training on inanimate models and 6 h hands-on training on normal human volunteers for appreciation of normal ultrasound anatomy (Moureau et al 2013).…”