Determination of the learning curve for ultrasound-guided jugular central venous catheter placement

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• 作者：Ba-Vinh Nguyen (1) (2)
  Gwenael Prat (1)
  Jean-Louis Vincent (3)
  Emmanuel Nowak (4)
  Nicolas Bizien (1)
  Jean-Marie Tonnelier (1)
  Anne Renault (1)
  Mehdi Ould-Ahmed (2)
  Jean-Michel Boles (1)
  Erwan Ler (1) (5)
  
• 关键词：Ultrasound ; Central venous catheter ; Education ; Learning curve
• 刊名：Intensive Care Medicine
• 出版年：2014
• 出版时间：January 2014
• 年：2014
• 卷：40
• 期：1
• 页码：66-73
• 全文大小：
• 作者单位：Ba-Vinh Nguyen (1) (2)
  Gwenael Prat (1)
  Jean-Louis Vincent (3)
  Emmanuel Nowak (4)
  Nicolas Bizien (1)
  Jean-Marie Tonnelier (1)
  Anne Renault (1)
  Mehdi Ould-Ahmed (2)
  Jean-Michel Boles (1)
  Erwan Ler (1) (5)
  
  1. Rnimation Micale, CHRU de La Cavale Blanche, Bvd Tanguy-Prigent, 29609, Brest Cedex, France
  2. Service dnesthie-Rnimation, Hpital dnstruction des Arms Clermont Tonnerre, Rue Colonel Fonferrier, 29200, Brest, France
  3. Department of Intensive Care, Erasme University Hospital, UniversitLibre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
  4. CIC INSERM U 0502, CHRU de Brest, Brest, France
  5. LATIM INSERM UMR 1101, CHRU de Brest, Universitde Bretagne Occidentale, Brest, France
  
• ISSN：1432-1238

文摘

Purpose Use of ultrasound (US) when introducing central venous catheters (CVC) may improve success rates, reduce the number of needle punctures, and decrease complication rates, but has been hampered by supposed difficulty in learning how to perform the technique. This study describes the learning curve for US-guided jugular CVC placement after a training program. Methods After an initial slide presentation and a video, intensivists who had not previously used US for CVC placement were evaluated qualitatively for US set up (score S1) and technical skills (score S2). Quantitative measures included durations of different components of the procedure (T 1, time from entry of the US into the patient room to sterile dressing of the intensivist; T 2, time needed for sterile drapes, venous line preparation, and sterile sheath placement; T 3, time from skin puncture to venous flashback; T 4, time from guide insertion to dressing; T tot, total duration of the procedure); number of skin punctures; and a difficulty score allocated by the intensivist. Results We performed 150 evaluations of 30 intensivists: 50% had no prior experience of CVC placement and 50% no prior US experience. Maximal S1 and S2 scores were obtained with the fourth and eighth placement procedures, respectively. T 1 and T 2 did not change with ongoing training (5 and 8min, respectively), but T 3 and T 4 decreased, from 5min (first procedure) to less than 1min (seventh procedure), and from 10min (first procedure) to 7min (sixth procedure), respectively. T tot decreased from 34 to 21min at the eighth procedure. The number of skin punctures and the difficulty score decreased rapidly with the number of evaluations. Conclusions Our study demonstrates that skills in US-guided CVC placement can easily be acquired with training.