title: Improving patient safety with ultrasonography guidance during internal jugular central venous catheter placement by novice practitioners.
abstract: BACKGROUND
  This study compared ultrasonography-guided (USG) placement with anatomic placement during internal jugular (IJ) central venous catheter (CVC) insertion by novice practitioners using a simulation model.
  
  
  METHODS
  A prospective, randomized, crossover study of 28 fourth year medical students was conducted with institutional review board approval. Participants viewed an instructional material before participation, and supervision was standardized. Participants were randomly assigned to either USG or traditional landmark method first, and each group served as its own crossover comparison. Paired t tests and χ analysis were performed on matched-pair data.
  
  
  RESULTS
  Fifty-four percent of participants had at least one arterial stick without USG compared with 0% when using USG. Significant differences were shown in the USG versus no-USG groups in number of needle advances until successful cannulation of the vein: mean with USG = 1.5 advances (95% CI, 1.0-1.9), mean without USG = 10.4 advances (95% CI, 7.8-13), P < 0.001; time to successful cannulation: mean with USG = 58 seconds (95% CI, 48-72 seconds), mean without USG = 338 seconds (95% CI, 286-390 seconds), P < 0.001; and success rates: 100% with USG and 42.8% without USG (95% CI, 24.5%-61.1%). The number needed to treat to avoid an arterial stick by using USG during IJ insertion by novice practitioners is ∼2.
  
  
  CONCLUSIONS
  The USG during IJ CVC placement by novice practitioners is essential to improve patient safety. If these data are extrapolated to impact on patient care, an arterial stick may be avoided in one of every two IJ CVCs placed by novice practitioners. The USG technology should be made available to novice practitioners needing to place CVCs.
authors.affiliation: Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA 19102, USA. sgriswol@drexelmed.edu
authors.forename: Sharon
authors.initials: S
authors.lastname: Griswold-Theodorson
authors.forename: Hashibul
authors.initials: H
authors.lastname: Hannan
authors.forename: Neal
authors.initials: N
authors.lastname: Handly
authors.forename: Brian
authors.initials: B
authors.lastname: Pugh
authors.forename: John
authors.initials: J
authors.lastname: Fojtik
authors.forename: Mark
authors.initials: M
authors.lastname: Saks
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hamilton
authors.forename: David
authors.initials: D
authors.lastname: Wagner
mesh_terms: D000046:Academic Medical Centers; D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods*; D002983:Clinical Competence; D018592:Cross-Over Studies; D004504:Education, Medical, Undergraduate; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D019300:Medical Errors / Q000517:prevention & control*; D011446:Prospective Studies; D017751:Safety Management; D013337:Students, Medical; D014463:Ultrasonography