Use of Ultrasound Guidance for Central Venous Catheter Placement: Survey From the American Board of Emergency Medicine Longitudinal Study of Emergency Physicians

Abstract

Objectives: The objective was to survey practicing emergency physicians (EPs) across the United States regarding the frequency of using ultrasound (US) guidance in central venous catheter (CVC) placement and, secondarily, to determine factors associated with the use or barriers to the use of US guidance.Methods: This was a cross-sectional survey mailed to presumed practicing EPs as part of the American Board of Emergency Medicine (ABEM)'s longitudinal study of EPs. The selection process used stratified, random sampling of cohorts thought to represent four different stages within the development of the specialty of emergency medicine (EM). Multivariable logistic regression was used to identify independent factors associated with both high comfort using US guidance and high-percentage usage of US guidance. Results:The survey was mailed to 1,165 subjects, and the response rate was 79%. The median number of years of practice was 20 (interquartile range [IQR] = 7 to 28 years). As their primary practice setting, 64% work in private or community hospitals, 60% received training in US-guided vascular access, and 44% never use US guidance in placing CVCs. Barriers differed in those who never use US and those who sometimes or always used US guidance. In those who never use US, top barriers were insufficient training (67%) and lack of equipment (25%). In those who use US, top barriers were the perceptions that US was too time-consuming (27%) and that the preferred site was not amenable to US (24%). Independent factors associated with high comfort and high-percentage use of US guidance were training in US-guided vascular access (adjusted odds ratio = 5.1 [high comfort]; 95% confidence interval [CI] = 2.6 to 10.1; adjusted odds ratio 11.1 = (high percentage); 95% CI = 5.0 to 24.8) and being a recent residency graduate.Conclusions: Among EPs, the translation of evidence to clinical practice regarding the benefits of US guidance for CVC placement is poor and still faces many barriers. Training and education are potentially the best ways to overcome such barriers.ACADEMIC EMERGENCY MEDICINE 2014;21:416-421

The practice of platelet transfusion prior to central venous catheterization in presence of coagulopathy: a national survey among clinicians

“…We did not look into motives for the omission of ultrasound during insertion. In a previous survey among emergency physicians in the United states, insufficient training and lack of equipment were identified as top barriers for the use of ultrasound during CVC placement . Other authors identified ‘no apparent need’ and limited availability of ultrasound equipment as important reasons not to use ultrasound .…”

Central Venous Catheterization

“…A previous study suggested that most practicing emergency physicians who work in nonacademic settings do not use ultrasound guidance for central venous catheterization. 22 Lack of training in ultrasound was reported as one of the important barriers to using ultrasound guidance in their practices. 22 Emergency physicians who have been trained in this technique become more comfortable adopting the procedure and are more likely to use it after graduation.…”

“…[16][17][18][19][20] The published evidence to date suggests that ultrasound guidance remains underused by emergency physicians. [21][22][23][24] To our knowledge, no prior studies have investigated the recent trends in the use of ultrasound guidance for central venous catheterization. The objectives of this study were to assess the selfreported frequency of use of ultrasound guidance for central venous catheterization by emergency medicine (EM) residents, describe residents' perceptions regarding the use of ultrasound guidance, and identify barriers to the use of ultrasound guidance.…”

Wireless Ultrasound‐Guided Axillary Vein Cannulation for the Implantation of Cardiovascular Implantable Electric Devices

“…Insufficient training, time consumption, or the need for a second operator to assist with image settings may be major barriers in its use. [10][11][12] In this study, we evaluate the effectiveness, time consumption, and safety of the first-in-human experience in axillary vein cannulation guided with a wireless ultrasound transducer (WUST) for the implantation of CIEDs. We hypothesized that the easier handling of a wireless probe (in comparison with a traditional one), in addition to the lack of the need for a second operator due to the capability of adjusting image settings directly from the probe, may be time saving, while the effectiveness and safety of ultrasound guidance would be maintained.…”