title: Use of ultrasound guidance improves central venous catheter insertion success rates among junior residents.
abstract: OBJECTIVE
  The purpose of this study was to determine whether junior residents had higher rates of first cannulation and overall success at central venous catheter insertions with the use of ultrasound (US) guidance compared to the landmark technique.
  
  
  METHODS
  We conducted a secondary analysis of data from a prospective randomized controlled study of junior residents from January 2007 through September 2008, which assessed the impact of simulation training on central venous catheter insertion success rates. Blinded independent raters observed in-hospital central venous catheter insertions using a procedural checklist. Success at first cannulation and successful insertion were the primary outcomes. Secondary outcomes included rates of technical errors and mechanical complications.
  
  
  RESULTS
  Independent raters observed 480 central venous catheter insertions by 115 residents. Successful first cannulation occurred in 27% of landmark compared to 49% of dynamic US-guided (P < .01), and 50% of static US-guided (P = .01) cannulations. Insertion success occurred for 55% of landmark compared to 80% of dynamic US-guided (P < .01) and 80% of static US-guided (P < .01) cannulations. Dynamic US guidance was associated with increased odds of first cannulation success compared to the landmark technique (odds ratio [OR], 2.24; 95% confidence interval [CI], 1.37-3.67) and successful insertion (OR, 3.80; 95% CI, 2.34-6.19). Static US guidance was associated with increased odds of first cannulation success compared to the landmark technique (OR, 2.59; 95% CI, 1.25-5.39) and successful insertion (OR, 3.48; 95% CI, 1.54-7.87). The results were independent of central venous catheter insertion training, patient comorbidities, and resident specialties. There was no difference related to mechanical complications between the procedures.
  
  
  CONCLUSIONS
  Dynamic and static US guidance during central venous catheter insertion was associated with improved in-hospital first cannulation rates and overall success rates of insertions by junior residents.
authors.affiliation: Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519, USA. kelly.dodge@yale.edu
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Dodge
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Lynch
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Moore
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Biroscak
authors.forename: Leigh V
authors.initials: LV
authors.lastname: Evans
mesh_terms: D059925:Anatomic Landmarks; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data*; D003237:Connecticut / Q000453:epidemiology; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D011361:Professional Competence / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional / Q000706:statistics & numerical data*