TITLE:
Teaching Ultrasound Imaging for Central Line Placement—A Resident’s Perspective
AUTHORS:
Jayanta Mukherji, Nil Ural, Taqdees Sheikh, W. Scott Jellish
KEYWORDS:
Ultrasound-Guided Technique; Vascular Access; Guidelines; Resident’s Perception
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.3 No.5,
July
19,
2013
ABSTRACT:
The availability of ultrasound (US)
devices has refined techniques for vascular access. The resident trainee’s
ability to learn US techniques depends upon device availability, skills, and
motivation of instructors. We hypothesized that hands-on teaching program of US
techniques for vascular access would have a positive impact on the trainee’s perceptions. After IRB approval, PGY3
anesthesiology residents with limited prior experience in US-guided vascular
access underwent close supervision by attending staff as they performed US-guided
Internal Jugular Vein (IJV) central line placements. A total of 66 land mark (LM) and 75 US-guided IJV
cannulation performed by 19 residents were supervised. Residents completing the study
were more proactive with 68.4% agreeing to use US based techniques for an anticipated difficulty in accessing
central lines. The graduating residents involved in the study all strongly
agreed that US imaging for vascular access was within the scope of practice of
all anesthesiologists, and that training guidelines be established and incorporated in their
practice. Fifty eight percent of residents stated that their confidence and
skill levels had significantly improved. Teaching US-guided techniques resulted
in an increase employment of such techniques by graduating residents with no
impediment attributed to knowledge deficits or inexperience. Residents were
more proactive with using
US for anticipated difficulty in IJV placement. A short neck, poor landmark,
anticoagulation, morbid obesity favored US use by residents. Systematic
teaching of US techniques is justified as it significantly improves the resident’s
perceptions and confidence.