A Comparative Study between Two Central Venous Access Techniques Performed by Junior Residents

Thales Paulo Batista

doi:10.15226/2374-684x/2/1/00117

Abstract

Objective: To evaluate the outcomes of Central Venous Access (CVAs) performed by junior residents (i.e. first-year residents) using the Subclavian (SC) and Internal Jugular (IJ) approaches. Methods: A comparative study was carried out in a prospective cohort of patients who consecutively underwent SC or IJ CVAs performed by junior residents at our Department of General Surgery. Additionally, we examined the impact of learning curve on the success of the venipunctures. Statistical analyses were developed using conventional nonparametric methods. Results: Overall, success and morbidity rates in our sample were 81% and 18%, respectively. Successful rates did not significantly differ between IJ and SC approaches (80.35% and 81.81%, respectively; p = 0.942), among procedures performed from first to fourth quartile periods (72% vs. 80% vs. 80% vs. 92%, respectively; p = 0.854) or regardless of which junior residents performed it (p = 0.662). Similarly, morbidity rates did not differ significantly according to CVA techniques (17.85% vs. 18.18%; p = 0.825), quartile periods (28% vs. 16% vs. 20% vs. 8%; p = 0.832), or which junior residents performed it (p = 0.743). There were significantly more arterial punctures/ hematoma using the IJ approach (7% vs. 1%, p = 0.024) and catheter malpositions/nonprogression after the SC technique (1% vs. 6%, p = 0.012). Conclusions: There was a different profile of complication rates with no differences between the techniques in term of either successful or early morbidity. Our study suggests that both approaches may be used for surgical training of junior residents in general surgery.

Highlights

Central Venous Access (CVA) is a common procedure in the management of various medical conditions, providing rapid access for fluid and blood administration, hemodynamic monitoring, pacemaker insertion, and maintenance of durable access for parenteral nutrition
One hundred-three consecutive patients undergoing CVA performed by our four junior residents from February 2011 to February 2012 were initially selected for analysis
Morbidity rates did not differ significantly according to CVA techniques (17.85% vs. 18.18%; p = 0.825), quartile periods (28% vs. 16% vs. 20% vs. 8%; p = 0.832), or which junior residents performed it (p = 0.743)

Summary

Introduction

Central Venous Access (CVA) is a common procedure in the management of various medical conditions, providing rapid access for fluid and blood administration, hemodynamic monitoring, pacemaker insertion, and maintenance of durable access for parenteral nutrition This procedure is often taught in residency training programs, and competency in this skill is a stated objective for many training programs in general surgery and subspecialties [1,2]. The standard landmark-guided Subclavian (SC) and Internal Jugular (IJ) approaches are common bedside procedures for CVAs performed by junior residents (i.e. first-year resident) in general surgery Despite both techniques appears similar in terms of either successful or complication rates [3,4], there are no clear evidence if any of these approaches is better to be taught initially during the early learning curve of training in surgical procedures. This current study aimed to evaluate these two different CVAs performed by junior residents, since an estimation of the outcomes might help guide medical educators in terms of where to focus their curriculum efforts

Methods

Results

Discussion

Conclusion