title: Establishing the learning curve for a tunneled dialysis catheter placement.
abstract: OBJECTIVE
  To determine how many procedures a surgical trainee requires before they are able to place a tunneled double-lumen dialysis catheter safely on their own.
  
  
  METHODS
  Surgical trainees unfamiliar with the procedure received a pre-operative briefing in which we explained 1) why, how, and in what particular order each operational step should be executed and 2) what the possible pitfalls/complications are. Next, an experienced surgeon demonstrated the procedure with the trainee scrubbed-in as their assistant. The trainee then performed all successive procedures, while the supervising surgeon acted as a silent observer and intervened only when an error was made. We recorded all errors as well as near misses and noted if they were severe, recurrent or unanticipated. At least three procedures were required but training was continued until less than three errors were made.
  
  
  RESULTS
  Ten trainees were included in the study. On average, a trainee made 11.9 mistakes during 3.4 procedures in a time span of 28.2 days. Only three trainees performed their last procedure flawlessly. The number of errors decreased exponentially from the first procedure onwards (P<.001). A statistically significant correlation was found between the number of mistakes and the number of days since the last procedure (P<.035). Unanticipated errors most frequently involved erroneous fluoroscopy interpretation, flushing with blood-contaminated saline, and incorrect volume injection for the heparin lock.
  
  
  CONCLUSIONS
  A theoretically well-prepared surgical trainee should be able to perform the placement of a tunneled dialysis catheter safely after four procedures. Training is more efficient when procedures follow each other quickly.
authors.affiliation: Department of Vascular Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium. dimitri.aerden@gmail.com
authors.forename: Dimitri
authors.initials: D
authors.lastname: Aerden
authors.forename: Simon
authors.initials: S
authors.lastname: van Hooland
authors.forename: Leslie
authors.initials: L
authors.lastname: Moerman
authors.forename: Lissa
authors.initials: L
authors.lastname: Pipeleers
authors.forename: Erik
authors.initials: E
authors.lastname: Debing
authors.forename: Pierre
authors.initials: P
authors.lastname: Van den Brande
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001530:Belgium; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling; D002983:Clinical Competence; D004867:Equipment Design; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D013647:Task Performance and Analysis; D013663:Teaching / Q000379:methods; D013997:Time Factors; D055815:Young Adult