PURPOSE: Ultrasound-guided (USG) internal jugular vein (IJV) cannulation has been shown to improve outcomes. However the optimal training program for medical residents has not been established. Our study aims to determine the success and complication rates of USG IJV cannulation by medical residents in critically ill adults after completion of a simulation-based training program.
METHODS: This was an observational cohort study of USG IJV insertions by medical residents rotating through medical ICU of a university-affiliated teaching hospital from March 2009 to March 2011. All residents underwent a training program consisting of 2 hours of didactics, 2 hours of simulation-based USG IJV insertion with 5 proctored examination prior enrolment. Demographic data of residents, successful cannulation rates and complications of USG IJV cannulation were collected.
RESULTS: A total of 337 USG IJVs were inserted by 31 residents. Their mean age was 28 years-old. The mean working experience was 29.6 months, with a mean ICU experience of 1.9 months prior enrolment. The average number of central lines inserted per resident via the landmark technique prior enrolment was 10. None had done USG IJV before or attended a formal training program. The success rate was 89.6% with first pass successful cannulation rate of 79.5%. There was a 5.93% complication rate of equal numbers of arterial puncture and hematoma. Success rate (98.6%), first pass success rate (90.0%) and complication rate (1.8%) were all significantly lower (p<0.05) from the 6th attempt onwards compared to their first 5 procedures.
CONCLUSIONS: Outcomes of USG IJV cannulation by medical residents completing the course was better compared to previously known rates of the landmark technique. We propose that 10 proctored examinations be conducted rather than 5 as this may result in even better results.
CLINICAL IMPLICATIONS: This study suggests that training program for medical residents consisting of 2 hours of didactics, 2 hours of simulation-based insertions with 10 proctored examinations results in improved outcomes of USG IJV insertion in the critically ill adult population.
DISCLOSURE: The following authors have nothing to disclose: Jansen Koh, Lifang Yeo
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