Effect of the implementation of NICE guidelines for ultrasound guidance on the complication rates associated with central venous catheter placement in patients presenting for routine surgery in a tertiary referral centre

Wigmore, Tim; Smythe, John; Hacking, Matthew; Raobaikady, R.; MacCallum, Niall

doi:10.1093/bja/aem262

Cited by 126 publications

(59 citation statements)

References 24 publications

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“…The implementation of National Institute for Clinical Excellence-UK guidelines has been associated with a significant reduction in complication rates in a UK tertiary referral center. 42 Similar recommendations, based on the published data of RCT meta-analyses, have been made by several scientific societies. 4,6,17 Most recently, the Association for Vascular Access has drafted a position statement on the use of realtime imaging for placement of central VADs (available at www.avainfo.org) advocating the use of ultrasound guidance for all nonemergent central vascular access procedures, including insertion of PICCs.…”

Section: Choice Of Venous Access and Role Of Ultrasound Guidancementioning

confidence: 88%

Vascular Access in Oncology Patients

Gallieni

Pittiruti

Biffi

2008

CA: A Cancer Journal for Clinicians

253

166

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Adequate vascular access is of paramount importance in oncology patients. It is important in the initial phase of surgical treatment or chemotherapy, as well as in the chronic management of advanced cancer and in the palliative care setting. We present an overview of the available vascular access devices and of the most relevant issues regarding insertion and management of vascular access. Particular emphasis is given to the use of ultrasound guidance as the preferred technique of insertion, which has dramatically decreased insertion-related complications. Vascular access management has considerably improved after the publication of effective guidelines for the appropriate nursing of the vascular device, which has reduced the risk of late complications, such as catheter-related bloodstream infection. However, many areas of clinical practice are still lacking an evidence-based background, such as the choice of the most appropriate vascular access device in each clinical situation, as well as prevention and treatment of thrombosis. We suggest an approach to the choice of the most appropriate vascular access device for the oncology patient, based on the literature available to date. (CA Cancer J Clin 2008;58:323-346.)

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Section: Choice Of Venous Access and Role Of Ultrasound Guidancementioning

confidence: 88%

Vascular Access in Oncology Patients

Gallieni

Pittiruti

Biffi

2008

CA: A Cancer Journal for Clinicians

253

166

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“…Fourth, our study did not examine residents in the use of ultrasound during simulator training. Use of ultrasound devices has been shown to decrease complication rates of CVC insertion 24 and increase rates of success, 25 and is recommended as the preferred method for insertion of elective internal jugular CVCs. 26 However, because our course was introduced during first-year residency, when majority of the residents have performed fewer than 5 internal jugular CVCs prior to their simulation training session, the objective of our introductory course was to first ensure technical competency by landmark techniques.…”

Section: Discussionmentioning

confidence: 99%

Improving internal medicine residents' performance, knowledge, and confidence in central venous catheterization using simulators

Millington

Wong

Kassen

et al. 2009

Journal of Hospital Medicine

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BACKGROUND:Efficacy of simulators in teaching central venous catheterization (CVC) in an internal medicine residency program is unknown.OBJECTIVE:To determine whether or not learning CVC on simulators is associated with improvement in performance of CVC, knowledge about the procedure, and self‐reported confidence.METHODS:All consenting first‐year internal medicine residents who completed training in CVC on simulators were included. Participants were evaluated pre‐ and post‐training by video‐recorded CVC insertion and multiple‐choice knowledge assessments. Procedural technique was rated in a blinded fashion by two independent adjudicators. Knowledge retention and self‐reported confidence were reassessed at 18 months.MEASUREMENTS:Primary outcome of CVC performance was assessed based on global rating score (minimum 1, maximum 5). Secondary measures include checklist score (out of ten), knowledge score and self‐reported confidence (6‐point Likert scale ranging from “none” to “complete”).RESULTS:Median global rating scores in 30 participants increased from 3.5 (IQR = 3‐4) to 4.5 (IQR = 4‐4.5) (P < 0.001). Checklist score increased from 9 (IQR = 6‐9.5) to 9.5 (IQR = 9‐9.5) (P < 0.001). Knowledge score increased from 65.7 ± 11.9% to 81.2 ± 10.7% (P < 0.001). Confidence increased from 3 (“moderate”, IQR = 2‐3) to 4 (“good”, IQR=3‐4) (P < 0.001). Sixteen participants completed the retention tests. Improvement in knowledge score and confidence at 18 months was retained compared with baseline (P = 0.002 and P < 0.0001 respectively).CONCLUSIONS:Use of simulators in teaching CVC in an internal medicine residency program results in improved procedural performance, knowledge, and self‐reported confidence. Improvement in knowledge and confidence was retained at 18 months. Journal of Hospital Medicine 2009;4:410–416. © 2009 Society of Hospital Medicine.

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“…2 The literature supports the use of ultrasound (US) guidance for CVC via the internal jugular approach. Compared to landmark techniques, a reduction in the risk of carotid injury and cannulation has been demonstrated with the use of US, 3 We describe an intraoperative carotid artery puncture during attempted internal jugular venous cannulation, which occurred despite the use of US.…”

Section: To the Editormentioning

confidence: 98%