848 Learning Curve in Performing Transradial and Ultrasound Guidance Vascular Access

Abstract

Transradial access is becoming the preferred technique for coronary angiography (CA) and percutaneous coronary intervention (PCI). Ultrasound (US)-guidance improves access efficiency and success rate. There have been no studies in Australia assessing operator training for US-guidance in this setting and thus this analysis aims to determine the number of procedures required to attain competency. As part of the SURF (Standard versus Ultrasound-guided Radial and Femoral access in coronary angiography and intervention) trial, we randomised 1388 patients undergoing CA and PCI into standard or US-guidance and radial or femoral access in a 2x2 factorial design. A total of 13 consultants, 7 fellows and 14 advanced trainees were involved in the study. Operators were required to have performed 50 standard and 10 US-guided punctures for both transradial and transfemoral access. There was an approximate learning curve, across all operators, suggesting that after 5 procedures, in addition to the 10 prior, operators attain competency in radial and femoral US-guidance. The average mean access time was reduced from 74s to 66.2s for US radial and from 60.5 to 51.5s for US femoral. Also, there was a 10% increase in first-pass success for radial-US after 5 procedures. There was no clear trend for standard transradial access. These results indicate that the learning curve for both US-guidance transradial and transfemoral access is easily achievable, irrespective of the level of experience with 15 procedures likely needed to attain competency. No clear trend for standard transradial access but 50 appears appropriate.