title: Ultrasound-guided central venous catheter placement by surgical trainees: a safe procedure?
abstract: BACKGROUND
  Central venous catheters (CVCs) are widely used to create a temporary or long-term access to the central venous system. A variety of treatments require a functional central venous access, including hemodialysis, administration of drugs, plasmapheresis and parenteral nutrition. The aim of this study was to evaluate the results of CVC placement performed by surgical trainees, according to a strict protocol of ultrasound-guided puncture and fluoroscopy-guided catheter insertion in a large teaching hospital in an outpatient setting.
  
  
  METHODS
  Between 1 January 2006 and 31 December 2008, 539 CVCs were placed, of which 486 were primary inserted by surgical trainees. All placements were ultrasound- and fluoroscopy-guided. After every placement operators recorded type of catheter, type of anesthesia, subcutaneous tunneling, technique of insertion and complications.
  
  
  RESULTS
  The study population consisted of 52% males. Access sites of CVCs were the internal jugular vein (91%), subclavian vein (5%) and other veins (3%). Technical success rate was 96.5%. Complication rate was 8.4%, of which 93% were arterial punctures. Pneumothorax occurred in three patients.
  
  
  CONCLUSIONS
  CVC placement by surgical trainees is a safe procedure when using a strict protocol of ultrasound-guided vessel puncture and fluoroscopic-guided catheter placement.
authors.affiliation: Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Marijn
authors.initials: M
authors.lastname: Hameeteman
authors.forename: Aron S
authors.initials: AS
authors.lastname: Bode
authors.forename: Arnoud G
authors.initials: AG
authors.lastname: Peppelenbosch
authors.forename: Frank M
authors.initials: FM
authors.lastname: van der Sande
authors.forename: Jan H M
authors.initials: JH
authors.lastname: Tordoir
mesh_terms: D000553:Ambulatory Care; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D004867:Equipment Design; D005260:Female; D005471:Fluoroscopy; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011030:Pneumothorax / Q000209:etiology; D015641:Radiography, Interventional; D018570:Risk Assessment; D012307:Risk Factors; D018084:Ultrasonography, Interventional; D014656:Vascular Surgical Procedures / Q000193:education*; D057772:Vascular System Injuries / Q000209:etiology