INTRODUCTION: This study compared ultrasonography-guided (USG) placement with anatomic placement during internal jugular (IJ) central venous catheter (CVC) insertion by novice practitioners using a simulation model. METHODS: A prospective, randomized, crossover study of 28 fourth year medical students was conducted with institutional review board approval. Participants viewed an instructional material before participation, and supervision was standardized. Participants were randomly assigned to either USG or traditional landmark method first, and each group served as its own crossover comparison. Paired t tests and χ analysis were performed on matched-pair data. RESULTS: Fifty-four percent of participants had at least one arterial stick without USG compared with 0% when using USG. Significant differences were shown in the USG versus no-USG groups in number of needle advances until successful cannulation of the vein: mean with USG = 1.5 advances (95% CI, 1.0-1.9), mean without USG = 10.4 advances (95% CI, 7.8-13), P < 0.001; time to successful cannulation: mean with USG = 58 seconds (95% CI, 48-72 seconds), mean without USG = 338 seconds (95% CI, 286-390 seconds), P < 0.001; and success rates: 100% with USG and 42.8% without USG (95% CI, 24.5%-61.1%). The number needed to treat to avoid an arterial stick by using USG during IJ insertion by novice practitioners is ∼2. CONCLUSIONS: The USG during IJ CVC placement by novice practitioners is essential to improve patient safety. If these data are extrapolated to impact on patient care, an arterial stick may be avoided in one of every two IJ CVCs placed by novice practitioners. The USG technology should be made available to novice practitioners needing to place CVCs.
RCT Entities:
INTRODUCTION: This study compared ultrasonography-guided (USG) placement with anatomic placement during internal jugular (IJ) central venous catheter (CVC) insertion by novice practitioners using a simulation model. METHODS: A prospective, randomized, crossover study of 28 fourth year medical students was conducted with institutional review board approval. Participants viewed an instructional material before participation, and supervision was standardized. Participants were randomly assigned to either USG or traditional landmark method first, and each group served as its own crossover comparison. Paired t tests and χ analysis were performed on matched-pair data. RESULTS: Fifty-four percent of participants had at least one arterial stick without USG compared with 0% when using USG. Significant differences were shown in the USG versus no-USG groups in number of needle advances until successful cannulation of the vein: mean with USG = 1.5 advances (95% CI, 1.0-1.9), mean without USG = 10.4 advances (95% CI, 7.8-13), P < 0.001; time to successful cannulation: mean with USG = 58 seconds (95% CI, 48-72 seconds), mean without USG = 338 seconds (95% CI, 286-390 seconds), P < 0.001; and success rates: 100% with USG and 42.8% without USG (95% CI, 24.5%-61.1%). The number needed to treat to avoid an arterial stick by using USG during IJ insertion by novice practitioners is ∼2. CONCLUSIONS: The USG during IJ CVC placement by novice practitioners is essential to improve patient safety. If these data are extrapolated to impact on patient care, an arterial stick may be avoided in one of every two IJ CVCs placed by novice practitioners. The USG technology should be made available to novice practitioners needing to place CVCs.
Authors: Richard A Hoppmann; Jeanette Mladenovic; Lawrence Melniker; Radu Badea; Michael Blaivas; Miguel Montorfano; Alfred Abuhamad; Vicki Noble; Arif Hussain; Gregor Prosen; Tomás Villen; Gabriele Via; Ramon Nogue; Craig Goodmurphy; Marcus Bastos; G Stephen Nace; Giovanni Volpicelli; Richard J Wakefield; Steve Wilson; Anjali Bhagra; Jongyeol Kim; David Bahner; Chris Fox; Ruth Riley; Peter Steinmetz; Bret P Nelson; John Pellerito; Levon N Nazarian; L Britt Wilson; Irene W Y Ma; David Amponsah; Keith R Barron; Renee K Dversdal; Mike Wagner; Anthony J Dean; David Tierney; James W Tsung; Paula Nocera; José Pazeli; Rachel Liu; Susanna Price; Luca Neri; Barbara Piccirillo; Adi Osman; Vaughan Lee; Nitha Naqvi; Tomislav Petrovic; Paul Bornemann; Maxime Valois; Jean-Francoise Lanctot; Robert Haddad; Deepak Govil; Laura A Hurtado; Vi Am Dinh; Robert M DePhilip; Beatrice Hoffmann; Resa E Lewiss; Nayana A Parange; Akira Nishisaki; Stephanie J Doniger; Paul Dallas; Kevin Bergman; J Oscar Barahona; Ximena Wortsman; R Stephen Smith; Craig A Sisson; James Palma; Mike Mallin; Liju Ahmed; Hassan Mustafa Journal: Ultrasound J Date: 2022-07-27