- Safety in training for ultrasound guided internal jugular vein CVC placement:. - a propensity score analysis. - Background: Central venous catheter (CVC) placement is a routine procedure but is potentially associated with severe complications. - The first aim of this study was to evaluate if resident proficiency affects the failure rate in CVC positioning under ultra- sound guidance. - To avoid bias the two cohorts were matched using propensity score.. - Among them, two groups of 1060 CVCs each were matched with a propensity score analysis. - There was no difference in the failure rate among the groups (2.8 vs 2.7%, p-value 0.895).. - Moreover, cohorts had the same rate of hematomas, catheter tip malposition, arterial puncture and pneumothorax.. - Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. - The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. - If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. - 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.. - The placement of a central venous catheter (CVC) is considered a routine procedure in both the intensive care ward and the operating room. - The use of ultrasound has been associated with fewer complications and is strongly recommended by current guidelines for internal jugular vein cannulation [3]. - Full list of author information is available at the end of the article. - Therefore, we designed this study to provide a clear quantification of the risk gap between PO and NPO. - Secondary objectives were rate of procedure complication (arterial puncture, hematoma formation at the puncture site, pneumothorax, hemothorax and CVC malposition).. - Study was approved by the Ethics Committee for Clinical Research of the Padova University Hospital (Chairman: Dr. - A retrospective review of the records of all patients requiring a CVC admitted to the procedure room of the University Hospital of Padova, from November 1, 2012 to July,92,020, was performed. - All ultrasound-guided. - internal jugular vein (IJV) cannulation with out-of-plane technique performed in the procedure room of our insti- tution were included in the study. - From the first year of residency residents follow frontal lessons (e.g. - In the procedure room of our institution CVC are posi- tioned by residents from the first to last year always under the direct supervision of a consultant. - Intervention may span from verbal correction and tips up to hand-on assistance, depending on the situation and expertise of the resident performing the procedure.. - The routine technique for CVC placement at our insti- tution is the out-of-plane technique: the probe is kept in a transverse position relative to the vessel while the nee- dle is advanced following an out-of-plane view (Fig. - After catheter insertion all the data relative to the proce- dure (number of operators, technique and complications) are reported on a specific register.. - We divided the CVC positioning procedures in two groups according to the operator’s proficiency (NPO group and PO group).. - Primary outcome was the rate of procedure failure, defined as the need for hands-on assistance of another operator during the procedure. - Secondary outcome was the rate of procedure complication (arterial puncture, hematoma formation at the puncture site, pneumotho- rax, hemothorax and CVC malposition) in NPO and PO groups.. - Needs for hands-on assistance, arterial puncture and hematoma formation were evaluated through inspection of the procedure room register.. - Hemothorax, pneumothorax and incorrect CVC posi- tion were evaluated through inspection of the post- procedure chest radiography and the CVC was defined as malpositioned if the tip of the catheter was placed outside veins or in subclavian, axillary or contralateral jugular vein. - We aimed to show a doubling incidence in the NPO group resulting in at least 739 couples (1478 total matched patients) with a power of 90% and a significance level of 0.05.. - The balance among the baseline cohorts and the final balance of the matched cohort was assessed using the standardized differences, with less than 0.05 chosen to indicate adequate balance.. - Among them, two groups of 1060 CVCs each were matched with a propensity score analysis, and standardized differences showed a balance among the matched cohorts.. - Twenty-two residents (6.2%) were in the PO group at the beginning of the study, while were in the NPO group at the end of the study. - All the remaining residents initially in the NPO group progressed to PO group as they reached the proficiency criteria.. - To the best of our knowledge, this is the largest study evaluating the skill-gap in ultrasound-guided CVC placement among PO and NPO.. - Overall Population Propensity score StD. - Overall Population Propensity score. - In their study neither success rate nor compli- cation rate was dependent on the experience of the punc- turing physician, however it was highly dependent on the proficiency of the ultrasound operator. - Therefore, it is not surprising that in Mey’s study [5], performed 20 years ago, the ultrasound operator’s proficiency was essen- tial for the correct visualization of the anatomical struc- ture and for the success of the procedure. - Rate of some complications such as arterial puncture and hematoma could have been affected by a recording bias, due to the absence in the analyzed dataset of monitoring and charting tools spe- cific for these complications.. - CVC: Central venous catheter. - IJV: Internal jugular vein. - ADC, FG, LP, AB, FZ, MT, CP, MP, MC and PN contributed to the study concep- tion and design. - The first draft of the manuscript was written by ADC. - The study is conducted according to the principles of the Declaration of Helsinki. - Malposition of central venous catheter in the jugular venous arch via external jugular vein -a case report. - Survey of central venous catheter depth using the Carina as a radiologic landmark in ICU patients.. - Ultrasound- guided internal jugular vein catheterization: a randomized controlled trial. - Evaluation of an ultrasound-guided technique for central venous access via the internal jugular vein in 493 patients. - Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit. - Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization.. - Preventing complications of central venous cath- eterization. - Central venous access catheters: radiological management of complications. - Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. - Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta- analysis. - Central venous catheterization training:. - Procedural complications of central venous catheter insertion
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