Point-of-care ultrasound training in Indian emergency medicine programs: A resident's perspective

Background and Objectives:Central venous catheter placement is a frequently performed procedure in emergency medicine as well as critical care unit. We aimed to compare real-time ultrasonography (USG)-guided and the traditional anatomical landmark (AL) technique for the insertion of internal jugular vein (IJV) catheters in an emergency department (ED) setting.Materials and Methods:Patients requiring IJV catheterization were prospectively recruited over a period of 1 year at a single center. Cannulation was done either by the AL or USG technique, according to ED physician's discretion. A preset pro forma was completed for each central line placed. Variables were compared using the independent t-test, Fisher's exact test, and the nonparametric Mann–Whitney U-test.Results and Discussion:Seventy patients were enrolled, of which 35 patients underwent IJV cannulation by USG-guided technique (USG group) and 35 patients by the AL technique (AL group). There were a 100% success rate (35/35) for cannulation in the USG group and a 91.4% success rate (32/35) in the AL group. The catheter was placed on the first attempt in 17 (48.6%) patients in the AL group and 32 (91.4%) patients in the USG group. In th AL group, there were three failed cannulation attempts in comparison to the USG group. The mean start to flash time for the AL technique was 16.59 s (±10.67) and 4.86 s (±2.18) in the USG group. The mean cannulation time was 305.88 s (±66.84) in the AL group and 293.03 s (±71.15) in the USG group. A total of seven acute complications were noted, of which 2 (5.7%) in the USG group and 5 (14.3%) in the AL group.Conclusion:The real-time USG guided technique significantly reduces the number of attempts to cannulate, has a higher first-pass success rate, a quicker flash time, and fewer complications when compared to the AL technique. In EDs equipped with USG, insertion of IJV catheters under real-time USG guidance should become the standard of care.

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“…All operators had additionally undergone a standardized certified ultrasound-based venous access course. [7]…”

Section: Methodsmentioning

confidence: 99%

A comparison of internal jugular vein cannulation by ultrasound-guided and anatomical landmark technique in resource-limited emergency department setting

et al. 2019

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“…A previous study of 41 Indian EM residents addressing US training in Indian EM programs found that eFAST was the examination most commonly performed, but noted a wide range of adoption of other indications and pointed to a need for a guideline/standardization of POCUS in the EM curriculum. 9 Our respondents represented a wide range of levels of training, with 24% having completed their residency and the remaining 76% relatively evenly divided among each of the 3 years of training. Interestingly, while the experience level of providers is quite evenly distributed (with representation gradually tapering off in the more senior respondents), the reported number of scans performed is nearly bimodal, with 26% having performed 0 to 10 and 28% having performed >100 scans.…”

Section: Discussionmentioning

confidence: 99%

“…This paper adds to a growing and important body of literature exploring the use of US in the international community. A previous study of 41 Indian EM residents addressing US training in Indian EM programs found that eFAST was the examination most commonly performed, but noted a wide range of adoption of other indications and pointed to a need for a guideline/standardization of POCUS in the EM curriculum 9 …”

Section: Discussionmentioning

confidence: 99%

Learner‐centered Survey of Point‐of‐care Ultrasound Training, Competence, and Implementation Barriers in Emergency Medicine Training Programs in India

Boniface

Drake

Pyle

et al. 2019

AEM Education and Training

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Background: Point-of-care ultrasound (POCUS) is important to the practice of emergency medicine (EM), but requires training to achieve competence. The purpose of this study was to describe the current state of POCUS practice and perceived barriers to the implementation in EM training programs in India. Methods: A cross-sectional survey consisting of 28 questions was administered to 378 faculty and residents in postgraduate EM training programs across India. Results: Data were collected from 159 physicians from 16 institutions; 76% of them were EM residents, with a response rate of 42%. Respondents overwhelmingly reported high interest (91%) in learning POCUS topics. Respondents identified highest levels of comfort with the performance and interpretation of trauma ultrasound (US) and echocardiography. Conversely, there was a scarce interest and low levels of competence in performing obstetric US, which may be a result of the practice of triaging these complaints to obstetricians and gynecologists. Lack of US equipment and dedicated training were the highest rated barriers by a significant margin, which 56% of respondents ranked as "very important." Conclusions: While significant interest in POCUS exists among the Indian EM physicians, comfort and competence were limited to trauma and echocardiography applications. Expansion of and comfort with POCUS use in these settings may be sought through improvement of access to US equipment and a dedicated US curriculum. P oint-of-care ultrasound (POCUS) has become a widely available and essential tool in the practice of emergency medicine (EM). Its importance in the field is demonstrated by its inclusion in the Model of Clinical Practice of Emergency Medicine as an "integral diagnostic procedure," 1 and it is now a recognized part of the curriculum in most EM residencies in the United States with dedicated didactics, clinical rotations, and evaluations of competency. 2

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Removing Barriers to Emergency Medicine Point-of-Care Ultrasound: Illustrated by a Roadmap for Emergency Medicine Point-of-Care Ultrasound Expansion in India

Smith,

Krishnan,

Leamon

et al. 2023

Journal of Emergencies, Trauma, and Shock

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Point-of-care ultrasound (PoCUS) has a potentially vital role to play in emergency medicine (EM), whether it be in high-, medium-, or low-resourced settings. However, numerous barriers are present which impede EM PoCUS implementation nationally and globally: (i) lack of a national practice guideline or scope of practice for EM PoCUS, (ii) resistance from non-PoCUS users of ultrasound imaging (USI) and lack of awareness from those who undertake parallel or post-EM patient care, and (iii) heterogeneous pattern of resources available in different institutes and settings. When combined with the Indian Preconception and Prenatal Diagnostic Techniques (PCPNDT) Act, this has led to the majority of India’s 1.4 billion citizens being unable to access EM PoCUS. In order to address these barriers (globally as well as with specific application to India), this article outlines the three core principles of EM PoCUS: (i) the remit of the EM PoCUS USI must be well defined a priori, (ii) the standard of EM PoCUS USI must be the same as that of non-PoCUS users of USI, and (iii) the imaging performed should align with subsequent clinical decision-making and resource availability. These principles are contextualized using an integrated PoCUS framework approach which is designed to provide a robust foundation for consolidation and expansion across different PoCUS specialisms and health-care settings. Thus, a range of mechanisms (from optimization of clinical practice through to PoCUS educational reform) are presented to address such barriers. For India, these are combined with specific mechanisms to address the PCPNDT Act, to provide the basis for influencing national legislation and instigating an addendum to the Act. By mapping to the recent Lancet Commission publication on transforming access to diagnostics, this provides a global and cross-discipline perspective for the recommendations.

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Point-of-care ultrasound training in Indian emergency medicine programs: A resident's perspective

Cited by 4 publications

References 12 publications

A comparison of internal jugular vein cannulation by ultrasound-guided and anatomical landmark technique in resource-limited emergency department setting

A comparison of internal jugular vein cannulation by ultrasound-guided and anatomical landmark technique in resource-limited emergency department setting

Learner‐centered Survey of Point‐of‐care Ultrasound Training, Competence, and Implementation Barriers in Emergency Medicine Training Programs in India

Removing Barriers to Emergency Medicine Point-of-Care Ultrasound: Illustrated by a Roadmap for Emergency Medicine Point-of-Care Ultrasound Expansion in India

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