Imaging |

Understanding the Use of Ultrasound Guidance for Central Venous Catheterization FREE TO VIEW

Holly Keyt, MD; Sandra Adams, MD; Stephanie Levine, MD; Timothy Houlihan, RN; Alejandro Arango, DDS; Jonathan Gelfond, MD; Marcos Restrepo, MD; Nilam Soni, MD
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University of Texas Health Science Center at San Antonio, San Antonio, TX

Chest. 2015;148(4_MeetingAbstracts):510A. doi:10.1378/chest.2246261
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SESSION TITLE: Imaging Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Millions of central venous catheters (CVCs) are placed annually in the United States for hemodynamic monitoring, delivery of medications, and nutritional support. Real-time ultrasound guidance for insertion of CVCs is recommended by national healthcare organizations and widely accepted as standard of care. Our study describes current practice patterns and identifies barriers to universal use of real-time ultrasound guidance for insertion of CVCs.

METHODS: A national, prospective, blinded, observational survey was conducted using REDCap. Attending physicians specializing in critical care medicine (CCM) or hospital medicine (HM) from the Chest and Society of Hospital Medicine databases were surveyed. Data were collected over 8 weeks and analyzed.

RESULTS: The survey response rate was 5.9% (1,012/17,233). The majority of physicians (81.8%) report prior training in ultrasound use for CVC insertion. Moderate to very frequent use of ultrasound guidance varies by site: internal jugular vein (97.5%), peripherally inserted central catheter (73.7%), femoral vein (55.8%), and subclavian vein (36.0%). Ultrasound training during post-graduate education (residency or fellowship) has the greatest impact on skill acquisition compared to bedside training by a colleague, industry- or professional society-sponsored workshops, or computer-based training. Additional ultrasound training is most desired for insertion of subclavian (35.0%), internal jugular (23.9%), and peripherally-inserted (23.7%) CVCs. The most frequently reported barriers to ultrasound use are limited availability of ultrasound equipment (22.4%) and increased procedure time (17.3%).

CONCLUSIONS: Most attending physicians specializing in CCM and HM in the United States report routine use of real time ultrasound guidance for CVC insertion in the internal jugular vein. Limited equipment availability and prolonged procedure time are the most common barriers to use of ultrasound.

CLINICAL IMPLICATIONS: Training in ultrasound-guided CVC insertion should continue to be emphasized in post-graduate medical education. Training options for subclavian and internal jugular vein catheterization, as well as peripherally-inserted central catheter insertion, may be attractive to a significant number of physicians. Hospital systems should work to improve availability of ultrasound machines.

DISCLOSURE: Sandra Adams: University grant monies: UT Patient Safety Grant, Grant monies (from sources other than industry): NIH and VA Cooperative Study, Grant monies (from industry related sources): AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis Marcos Restrepo: Grant monies (from sources other than industry): NIH and VA Cooperative Study The following authors have nothing to disclose: Holly Keyt, Stephanie Levine, Timothy Houlihan, Alejandro Arango, Jonathan Gelfond, Nilam Soni

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