PURPOSE:Central venous catheter (CVC) insertion is one of the most common procedures performed in the intensive care unit, however it is associated with various complications. The purpose of our study was to evaluate the effectiveness of an educational program and instruction in ultrasound guidance in reducing mechanical complications associated with CVC insertion.
METHODS:This is a single center observational study. The study population was patients admitted to the Medical Intensive Care Unit (MICU) and Respiratory Stepdown Unit (RSU) of a large urban teaching hospital in New York City. Over a six month period, resident level medical house staff rotating through the MICU and RSU received an hour of interactive lecture and a video demonstration, and forty five minutes of hands on training using mannequins. Data was collected by chart review of procedure notes, direct confirmation of CVC placement at the bedside, and discussion with the MICU and RSU staff. Data collection consisted of operator, patient, and procedure characteristics, and complications.
RESULTS:Our data was compared to a prior six month series from the same institution. At that time there was no formal training curriculum in CVC placement, and ultrasound was infrequently used. Our data showed 402 consecutive CVC attempts with 61.4% ultrasound guidance, compared to the previous study of 334 consecutive CVC attempts with 3.0% ultrasound guidance. The pneumothorax rate went from 1.8% to 0.41% (P=0.202), the arterial puncture rate went from 4.2% to 1.5% (P=0.038), and the placement failure rate went from 22.8% to 16.2% (P= 0.030).
CONCLUSION:Our data suggests that the pre-rotation training and ultrasound technique resulted in a higher success rate and fewer mechanical complications.
CLINICAL IMPLICATIONS:Complications from CVC placement, including arterial puncture and placement failure, continue to pose significant risks to our patients. Interactive education with hands-on training in line placement and the use of ultrasound guidance significantly reduced these risks.
DISCLOSURE:Hiroshi Sekiguchi, No Financial Disclosure Information; No Product/Research Disclosure Information