title: Achieving optimal clinical outcomes in ultrasound-guided central venous catheterizations of the internal jugular vein after a simulation-based training program for novice learners.
abstract: BACKGROUND
  The aim of this study was to determine the number of ultrasound-guided (USG) central venous catheterization (CVC) of the internal jugular vein (IJV) residents had to perform, after a simulation-based training program, to achieve optimal clinical outcomes.
  
  
  METHODS
  We conducted a single-center, prospective, observational study in the medical intensive care unit of a university-affiliated teaching hospital. Residents participated in a formal training program, consisting of a simulation-based workshop and 5 supervised USG CVC insertions on patients. Subsequent USG CVC of the IJV performed by residents during their rotation were assessed. Data on the overall success (OS), first pass success (FP) and mechanical complication (MC) rates were serially collected over 2 years, spanning 4 cohorts of residents.
  
  
  RESULTS
  Thirty-two residents performed a total of 337 USG CVC of the IJV. Residents had previously performed an average of 9 CVC via the landmark technique. None had performed USG CVC before. Results showed that residents improved in their OS, FP, and MC rates as they performed more USG CVC. Residents needed to perform 7 USG CVCs to achieve optimal clinical outcomes of high OS and FP as well as low MC rates. There was a significant improvement in OS, FP, and MC rates for the eighth and subsequent USG CVCs compared with the first 7 USG CVCs (82% vs. 99% [P < 0.001], 70% vs. 92% [P < 0.001] and 11% vs. 0%, respectively).
  
  
  CONCLUSIONS
  After a formal training program consisting of a simulation-based workshop and 5 supervised USG CVCs on critically ill adults, residents were able to achieve optimal clinical outcomes after performing 7 procedures.
authors.affiliation: From the Department of Respiratory and Critical Care Medicine (J.K., L.Y., A.T., S.C., J.L., I.B.M.N., V.P., J.R., A.V., A.N.), Changi General Hospital; and Duke-NUS Graduate Medical School (Y.X.), Singapore.
authors.forename: Jansen
authors.initials: J
authors.lastname: Koh
authors.forename: Ying
authors.initials: Y
authors.lastname: Xu
authors.forename: LiFang
authors.initials: L
authors.lastname: Yeo
authors.forename: Augustine
authors.initials: A
authors.lastname: Tee
authors.forename: Siau
authors.initials: S
authors.lastname: Chuin
authors.forename: John
authors.initials: J
authors.lastname: Law
authors.forename: Imran Bin Mohd
authors.initials: IB
authors.lastname: Noor
authors.forename: Vijo
authors.initials: V
authors.lastname: Poulose
authors.forename: Jagadesan
authors.initials: J
authors.lastname: Raghuram
authors.forename: Akash
authors.initials: A
authors.lastname: Verma
authors.forename: Alvin
authors.initials: A
authors.lastname: Ng
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000379:methods*; D002983:Clinical Competence; D003198:Computer Simulation; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D007396:Internship and Residency / Q000379:methods*; D007601:Jugular Veins; D007858:Learning; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D011446:Prospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*; D055815:Young Adult