Learning Curves for Training in Ultrasonography-Based Examination of Umbilical Catheter Placement: A Piglet Study

Abstract

Background: The training required for accurate assessment of umbilical catheter placement by ultrasonography (US) is unknown. Objective: To describe the learning curve and provide an estimate of the accuracy of physicians' US examinations (US skills) and self-confidence when examining umbilical catheter tip placement. Methods: Twenty-one physicians with minimal experience in US completed a 1.5-hour eLearning module. Ten piglets with catheters inserted in the umbilical vessels were used as training objects. Following eLearning each physician performed up to twelve 10-min US examinations of the piglets. Expert examinations were reference standards. Sensitivity and specificity of physicians' skills in detecting catheter tip placement by US was used to describe the learning curve. Self-confidence was reported by Likert scale after each examination. Results: Physicians' detection of a correctly placed and misplaced umbilical artery catheter tip increased by an odds ratio of 1.6 (95% CI: 1.1, 2.3) and 3.6 (95% CI: 1.7, 7.8) per examination performed. A sensitivity of 0.97 (95% CI: 0.80, 0.99) and specificity of 0.95 (95% CI: 0.84, 0.99) was reached after 6 examinations. For the venous catheter, US skills in detecting a misplaced catheter tip increased with an odds ratio of 2.4 (95% CI: 1.2, 4.8) per US examination. Overall, performance and self-confidence plateaus were reached after 6 examinations. Conclusion: We found steep learning curves for targeted US examination of umbilical catheter placement. eLearning followed by 6 examinations was found to be adequate training to perform with a sufficiently high accuracy and self-confidence to allow for point-of-care use.

Real-time ultrasound for tip location of umbilical venous catheter in neonates: a pre/post intervention study

“…Our study demonstrates that a focused intervention, such as a targeted training, can increase awareness of the benefits and consequently implement the use of a technique that has already been validated as the gold standard for catheter tip location. To the best of our knowledge there are only few studies focusing on a well-established and specific training of the neonatal medical staff on the use of US in UVC line placing, one of which used an animal model [ 17 , 31 ].…”

Umbilical Venous Catheter Update: A Narrative Review Including Ultrasound and Training

“…In a recent experimental study, Kaee et al investigated the learning curve for targeted ultrasound evaluation of UVC placement in physicians with low experience in ultrasound use in a piglet model. After a short eLearning module and a few practical sessions, trainees were able to detect the catheter's tip with accuracy and high self-confidence score within 10 min ( 47 ). A recent pre/post intervention study demonstrated the feasibility of targeted training on the use of POCUS for UVC placement in NICU among neonatal medical staff.…”

Umbilical vein catheterisation for the family physician working in primary health care

“…7 Adequate training is needed prior to the utilisation of PoCUS and achievement of the required competence is feasible following a very brief training period. 22 …”