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Improving patient safety with ultrasonography guidance during internal jugular central venous catheter placement by novice practitioners
Journal article   Open access

Improving patient safety with ultrasonography guidance during internal jugular central venous catheter placement by novice practitioners

Sharon Griswold-Theodorson, Hashibul Hannan, Neal Handly, Brian Pugh, John Fojtik, Mark Saks, Richard J Hamilton and David Wagner
Simulation in healthcare : journal of the Society for Medical Simulation, v 4(4), pp 212-216
2009
DOI: https://doi.org/10.1097/SIH.0b013e3181b1b837
PMID: 21330794
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1097/sih.0b013e3181b1b837View
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze),  Open

Abstract

Academic Medical Centers Catheterization, Central Venous - instrumentation Catheterization, Central Venous - methods Clinical Competence Cross-Over Studies Education, Medical, Undergraduate Humans Jugular Veins - diagnostic imaging Medical Errors - prevention & control Prospective Studies Safety Management Students, Medical Ultrasonography
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. 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. 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. 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.

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22 citations in Scopus

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