Effectiveness of Training in Real-Time Ultrasound- Guided Central Venous Catheter Placement in a Medical Center

Chu-Hsien Wang ； Che Lin ； Chin-Yi Huang ； Yi-Chun Kao ； Yi-Ju Lin ； Hsin-Shun Tseng ； Chih-Cheng Lin ； Yu-Ching Tseng ； Lon-Yen Tsao ； Han-Yao Chiu ； Rei-Cheng Yang ； Ming-Sheng Lee

《The Changhua Journal of Medicine》 16卷1期 (2018/03) Pp. 14-21

https://doi.org/10.6501/CJM.201803_16(1).0002

摘要

Central venous catheter (CVC) placement is a common clinical procedure in medical centers. As the use of real-time ultrasound (US) guidance for CVC insertion increases the cannulation success rate and reduces complications in patients, this study organized educational training in a Clinical Skills and Simulation Center to investigate the effectiveness of adopting realtime US-guided CVC placement in medical centers. A total of 82 training courses in real-time US-guided central venous catheterization were conducted at the Clinical Skills and Simulation Center of Changhua Christian Hospital from January 2012 to January 2016. Specifically, on-shift nursing personnel were instructed to record the insertion techniques adopted clinically by physicians (trained or untrained) for CVC placement from January 2016 to August 2016. The insertion records were categorized into the real-time US-guided approach, static US-guided approach, and traditional landmark-guided approach, and the number of attempts required for successful catheterization and the ensuing complication rates for each approach were compared. A total of 804 clinical records for 652 patients treated by 74 trained physicians and 152 patients treated by 31 physicians without training were analyzed in this study. The average number of attempts required for successful insertion by physicians with and without training was 1.32 ± 0.81 versus 1.68 ± 1.79 (p = 0.186) using the traditional landmarkguided approach, 1.57 ± 1.13 versus 2.00 ± 1.87 (p = 0.148) using the static USguided approach, and 1.52 ± 1.10 versus 2.37 ± 2.16 (p = 0.003) using the realtime US-guided approach, respectively. We concluded that medical centers should deliver adequate training in the application of real-time US-guided CVC insertion to enhance the successful catheterization rate.

關鍵字

central venous catheter ； echo ； education ； real-time ultrasound