Description #
There are 2 components to knowing how to perform a procedure: 1) cognitive understanding of the procedure (i.e. indications, contraindications, complications, ordered steps) and 2) the psychomotor coordination and technical skill of performing the procedure itself. The unit will be organized into phases, moving from purely cognitive to progressively more psychomotor skill acquisition.
Phase1: Pre-course reading materials to include indications, contraindications, complications, ordered steps of each procedure.
Phase 2: Instructor demonstrates performance of the procedure. The learner then performs the procedure on a simulation model with supervision and feedback from the instructor.
Phase 3: Human Patient Simulator and Simman simulation scenarios. The learner must now manage the resuscitation of a critically ill patient in parallel with clinical decision-making, team leadership, and appropriate timing of the procedure during real-time patient encounters.
Learning Objectives #
At the end of this unit, learners should be able to perform:
1. Ultrasound-guided Central line placement in the Jugular or Femoral veins.
Article 1 #
Final Appraisal Determination: Ultrasound locating devices for placing central venous catheters #
Article 2 #
Making Health Care Safer A Critical Analysis of Patient Safety Practices #
Article 3 #
Real-Time Ultrasonographically-Guided Internal Jugular Vein Catheterization in the Emergency Department Increases Success Rates and Reduces Complications: A Randomized, Prospective Study
Annals of emergency medicine 2006, vol. 48, no5, pp. 540-547
Julie Leung, Martin Duffy, Andrew Finckh
Study objective
We compare real-time ultrasonographic guidance and the traditional landmark technique for the insertion of internal jugular vein catheters in an emergency department (ED) setting.
Methods
This was a prospective, randomized, clinical study performed in a tertiary ED between August 2003 and May 2005 on patients requiring central venous access. Ultrasonographically guided catheters were inserted under real time using the Sonosite ultrasonographic system with a 10 to 5 MHz 38-mm linear array transducer. Standardized data were collected on operator experience, method of insertion, reason for central venous access, and comorbidities. Outcome measures included successful insertion of an internal jugular vein catheter, number of attempts, access times, and complications.
Results
One hundred thirty patients were enrolled. Cannulation of the internal jugular vein was successful in 61 of 65 patients (93.9%) using ultrasonography and in 51 of 65 patients (78.5%) using the landmark technique, a significant difference of 15.4% (P=.009, 95% confidence interval [CI] 3.8% to 27.0%). Fifty of 61 (82.0%) of the successful ultrasonographically guided catheters were inserted on the first attempt compared with 36 of 51 (70.6%) of the successful landmark catheters. Mean access times to venipuncture and successful insertion were 138 and 281 seconds by ultrasonographic guidance and 132 and 271 seconds by the landmark technique. There was a 10.8% complication rate, with 11 complications (16.9%) in the landmark group and 3 (4.6%) in the ultrasonographic group, a difference of 12.3% (95% CI 1.9% to 22.8%).
Conclusion
Ultrasonographically guided internal jugular vein catheterization in the ED setting was associated with a higher successful insertion rate and a lower complications rate.
Central Line Placement Lecture Video