Purpose:

To develop and implement a comprehensive program to train providers to place subclavian central venous catheters (CVCs) using real-time ultrasound guidance.

Study design:

Simulation-based prospective study at an academic medical center. Of 228 anesthesia providers and intensivists eligible to participate, 106 participants voluntarily enrolled. The training program consisted of a didactic module, hands-on instruction and practice using a CVC simulator and a standardized patient. The success of the program was measured by pre and post knowledge tests and direct observation during the hands-on sessions.

Results:

Of 106 participants who enrolled, 70 successfully completed the program. Out of 20 possible procedure steps, an average of 17.8 ± 2.9 were correctly performed in the simulated environment. The average time to needle insertion, defined by positive aspiration of stained saline, was 3.35 ± 3.02 min and the average time to wire insertion with ultrasound confirmation was 3.85 ± 3.12 min.

Conclusions:

Participants learned how to successfully perform ultrasound-guided catheterization of the subclavian vein. Since ultrasound-guided subclavian CVC placement is a useful clinical skill that many practitioners are unfamiliar with, increasing competence and comfort with this procedure is an important goal. Other centers could consider adopting an approach similar to ours to train their providers to perform this technique.

中文翻译：

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锁骨下静脉实时超声引导导管插入术培训计划

目的：

制定和实施一项综合计划，培训提供者使用实时超声引导放置锁骨下中心静脉导管 (CVC)。

学习规划：

在学术医疗中心进行基于模拟的前瞻性研究。在有资格参与的 228 名麻醉提供者和重症监护医生中，有 106 名参与者自愿参加。培训计划包括教学模块、动手指导和使用 CVC 模拟器和标准化患者的练习。该计划的成功是通过前后知识测试以及在动手会议期间的直接观察来衡量的。

结果：

在注册的 106 名参与者中，有 70 人成功完成了该计划。在 20 个可能的程序步骤中，平均 17.8 ± 2.9 在模拟环境中正确执行。针插入的平均时间（由染色盐水的阳性抽吸定义）为 3.35 ± 3.02 分钟，经超声确认的导线插入的平均时间为 3.85 ± 3.12 分钟。

结论：

参与者学习了如何成功地进行锁骨下静脉的超声引导导管插入术。由于超声引导下锁骨下 CVC 放置是许多从业者不熟悉的有用的临床技能，因此提高该过程的能力和舒适度是一个重要目标。其他中心可以考虑采用类似于我们的方法来培训他们的提供者执行这项技术。