Jugular Central Venous Catheter Research Articles

Additionally using transthoracic echocardiography during ultrasound-guided jugular central venous catheter placement and the odds of catheter misplacement in children: A before-and-after study.

Central venous catheter (CVC) misplacement is a major complication.1 To avoid CVC misplacement, real-time ultrasound (US) guidance is recommended for CVC placement in children.2, 3 Transthoracic echocardiography (TTE) can be additionally used to confirm correct CVC tip position.4, 5 Whether additionally using TTE during US-guided jugular CVC placement reduces the incidence of catheter misplacement remains scarcely described. We thus sought to test the hypothesis that additionally using TTE during US-guided jugular CVC placement reduces the odds of CVC misplacement in children. After approval by the ethics committee with waiver of informed consent, we performed a retrospective before-and-after study in children aged 0–6 years who received a jugular CVC during anesthetic induction for congenital heart disease surgery at the University Medical Center Hamburg-Eppendorf (Hamburg, Germany) between March 2015 and April 2020. In our institution, jugular CVCs in children having cardiac surgery are routinely placed using real-time US guidance since 2013. In October 2017, routine use of additional TTE during US-guided jugular CVC placement was implemented. In the 31-month “before period” (March 2015 to September 2017), anesthesiologists did not use TTE but chose the CVC insertion depth considering patient height (no-TTE-group). In the 31-month “after period” (October 2017 to April 2020), additional TTE (subcostal long-axis view) was routinely used during US-guided jugular CVC placement to confirm the correct position of the guidewire and the CVC tip (rapid saline flush test) (TTE-group) (Figure S1). During both study periods, chest x-ray was used to confirm correct CVC tip position after surgery. We categorized CVCs as misplaced when the CVC tip ended above the level of the superior vena cava in a noncentral vein or deep in the right atrium (Figure S2). We investigated the associations between CVC misplacement and TTE use by logistic regression for all patients including age as covariate—and separately for patients aged <1 year and 1–6 years. We report the odds ratios (OR) with 95% confidence intervals. We included 373 patients (156 no-TTE-group and 217 TTE-group) (Table S1). CVC misplacement occurred in 15/156 no-TTE-group patients (9.6%) and in 5/217 TTE-group patients (2.3%). The odds for CVC misplacement were 371% lower when TTE was used compared to when it was not used (p = .004, OR = 0.21 [0.067–0.57]) (Figure 1). Of all 373 patients, 229 (61%) were younger than 1 year. In these patients, CVC misplacement occurred in 8/76 no-TTE-group patients (11%) and in 4/153 TTE-group patients (2.6%). The odds for CVC misplacement were 319% lower when TTE was used (p = .023, OR = 0.24 [0.062–0.79]). Of all 373 patients, 144 (39%) were between 1 and 6 years old. In these patients, CVC misplacement occurred in 7/80 no-TTE-group patients (8.8%) and in 1/64 TTE-group patients (1.6%). The odds for CVC misplacement were 480% lower when TTE was used (p = .107, OR = 0.17 [0.0090–1.0]). In our study, additionally using TTE during US-guided jugular CVC placement in children reduced the odds for CVC misplacement by more than 300%—which obviously is clinically meaningful. In only about 1% of children, the subcostal long-axis view could not be obtained—and TTE could thus not be used to confirm the CVC tip position. In general, children provide an excellent acoustic window for TTE examination of the right atrium and the superior vena cava. Nevertheless, TTE requires technical skills and operator experience. Our results need to be interpreted in light of the inherent limitations of retrospective before-and-after studies. Additionally, we only included children with congenital heart disease, whose anatomy may differ from healthy children. However, as we excluded patients with irregular venous conformations, we assume that our findings can be transferred to pediatric patients in general. Additionally using TTE during US-guided jugular CVC placement reduces the odds of CVC misplacement in children aged 0–6 years. Clinicians should consider additionally using TTE during US-guided jugular CVC placement to increase patient safety. This work was supported solely from institutional and/or department sources. There are no conflicts of interest to declare. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Supporting Information Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Outcomes of early-start peritoneal dialysis (PD) and the comparison with urgent-start hemodialysis and conventional-start PD.

Limited data in the literature is comparing early-start peritoneal dialysis (PD), urgent-start hemodialysis (HD) with the jugular central venous catheter (CVC), and conventional-start PD. This retrospective study was conducted with 148 patients with early-start PD, 104 patients with conventional-start PD, and 100 patients with urgent-start HD. Early-start PD was defined as catheter break-in time between 3 and 14 days. The occurrence of dialysate-leakage was similar between PD groups (p=0.1). Bleeding at the catheter site was detected in 8 (2.3%) patients with CVC. There was no significant difference in catheter dysfunction and revision. PD groups had statistically similar peritonitis rates (p=0.5). 19% (19/100) of patients suffered CVC-related bloodstream infection and one patient died due to septic shock. Technique survival was significantly higher at early-start PD than the conventional-start PD at 6 months (p=0.02). Initiating early-start PD is comparable with conventional-start PD, and it may be an alternative dialysis modality to avoid bloodstream infections in suitable patients.

Lymphorrhea following Tunneled Femoral Central Venous Catheter Placement: Avoidance and Management of a Rare Complication.

Lymphatic injury and chylothorax are known, albeit rare, complications of both right and left internal jugular central venous catheter placement.[1] [2] Some reports suggest that these complications occur more frequently when lines are placed in the presence of other complicating factors such as infection or thrombosis.[3] [4] [5] [6] [7] [8] Although rare, the potential for a peripheral lymphatic injury is present during vascular access adjacent to the inguinal nodal cluster. A case of iatrogenic peripheral lymphatic injury during placement of a femoral tunneled central venous catheter (TCVC) is described. We review peripheral lymphatic anatomy, suggest approaches to avoid inadvertent lymphatic injury, and discuss management strategies of a peripheral lymphatic injury.

MALPOSITION OF RIGHT INTERNAL JUGULAR VEIN CATHETER IN RIGHT AXILLARY VEIN: A RARE CASE DIAGNOSED BY BEDSIDE ULTRASOUND

MALPOSITION OF RIGHT INTERNAL JUGULAR VEIN CATHETER IN RIGHT AXILLARY VEIN: A RARE CASE DIAGNOSED BY BEDSIDE ULTRASOUND

364 A Dangerous Case of the “Goldilocks Effect”: Experimental Demonstration of Potential Vascular Injury Mechanism with Central Venous Catheter Insertion

364 A Dangerous Case of the “Goldilocks Effect”: Experimental Demonstration of Potential Vascular Injury Mechanism with Central Venous Catheter Insertion

PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION DIAGNOSED AFTER CENTRAL VENOUS CATHETER PLACEMENT

PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION DIAGNOSED AFTER CENTRAL VENOUS CATHETER PLACEMENT

Elderly man with abnormal chest radiograph after central venous catheter insertion.

A 78-year-old male presented to the emergency department with septic shock. A left-sided internal jugular central venous catheter (CVC) was inserted using ultrasound guidance. A routine post-procedure chest radiograph was obtained to confirm CVC placement (Figure 1). The chest radiograph findings raised concerns for the possibility of an unanticipated carotid artery placement as the intraluminal catheter did not appear to cross the midline and terminated in an abnormal left paramediastinal location. A follow-up computed tomography (CT) scan of the chest was performed to further evaluate line positioning (Figure 2 and 3). The prevalence of left-sided SVC is unknown as it is often silent and detected incidentally on imaging, though estimates range from 0.3% to 3%.1 Paired transient anterior cardinal veins are present during routine fetal development. The left anterior cardinal vein typically involutes and the right anterior cardinal vein enlarges to form the SVC. A left-sided SVC is a congenital anomaly resulting from the failure of the left anterior cardinal vein to obliterate.2 A left-sided SVC typically drains into the right atrium via the coronarysinus, though the precise vascular anatomy may be challenging to delineate in the absence of intravenous contrast.3 Infrequently, it drains into the left atrium causing a right-to-left shunt most frequently without significant cyanosis.3 Inadvertent arterial placement is the principal consideration that should be excluded when a left-sided CVC fails to cross the midline as anticipated. Occasional anatomic variants may exist that can be more readily delineated with the use of cross-sectional imaging if needed. In this case, after confirmation of the anatomical variation and adequate venous placement by CT imaging, the catheter was used without issue or complication.

Assessment of the acceptable length of right internal jugular central venous catheters for Indian population

Background: Central venous catheters have been used in various lengths based on the height of the patient or predetermined lengths. This study compared the different lengths of right IJV central venous catheters to determine the better length for average heights of Indian population. Patients and Methods: This was a prospective observational study done on 148 patients with average heights of Indian population (160±10cm) who are scheduled for right IJV central venous catheters are a part of this study. The patients are divided into 3 group (10,13,15 cm). Three different lengths of catheters are inserted. An anteroposterior chest X-ray was taken for the patients and carina was taken as the acceptable landmark. The outcome measured between the three groups is need for repositioning. Statistical analysis was done using Chi square test, Fisher’s exact test. Results: 10 cm catheters were considered acceptable in terms of less incidence of repositioning and statistically significant with p value of 0.0001(H S) with respect to other lengths (13,15cm) for heights of average Indian population. (160±10 cm). Conclusion: From our study, we concluded that 10 cm CVC catheters are acceptable in cannulating right IJV for an average Indian height adult patients (160±10 cms).

Preparing for the lasting effects of COVID-19 on medical training: The design and pilot study of a low-fidelity virtual reality prototype for Central Venous Catheterization training.

Over the last several decades we have seen a shift from in-person to online training that has been exasperated by the COVID-19 pandemic. Researchers believe that many of these effects will be lasting which makes it even more important that the Human Factors community seek to step back and understand how to best train complex skills in a virtual world. The current paper is focused on understanding the utility of Virtual Reality (VR) in medical education for a hands-on procedural heavy procedure - ultrasound-guided Internal Jugular Central Venous Catheterization. Specifically, the objective of this study is to identify the potential utility of VR in US-IJCVC training through the design of a low-fidelity prototype and user interviews with three subject-matter experts. Results showed that the VR prototype designed is useful and provides a depth of knowledge and educational value which can be used to design innovative VR training approaches.

Scheduled removal of central venous catheters (CVC) to prevent CVC-related bloodstream infections in patients with hematological disease or autologous stem cell transplantation: a registry-based randomized simulation-study

Although not generally recommended, scheduled central venous catheter (CVC) removal is sometimes carried out in order to reduce the CVC-related bloodstream infection (CRBSI) incidence. We conducted a simulation for scheduled CVC removal within the multicenter CRBSI registry (SECRECY). Non-tunneled jugular and subclavian CVC in patients with hematological disease or with germ cell tumors (including patients receiving autologous stem cell transplantation [SCT]) were included. Cases were randomized in a 1:1:1:1 ratio to either a simulated, scheduled CVC removal after 7, 14, and 21 days, or to non-simulated, unscheduled CVC removal (control group). The primary endpoint was definitive CRBSI incidence for a scheduled CVC removal after 14 days (dCRBSI-D14rmv). Among other, secondary endpoints were definite CRBSI incidence for a scheduled removal after 7 days (dCRBSI-D7rmv) and 21 days (dCRBSI-D21rmv). Data on 2984 CVC were included. Patients’ median age was 59 (range 16–95) years, 58.8% being male. The vast majority (98.4%) were patients with hematological malignancies. Jugular veins were the main insertion site (93.2%). dCRBSI-D14rmv was 3.10/1000 CVC days as compared to 4.15/1000 CVC days in the control group (p = 0.23). There was a significant difference between dCRBSI-D7rmv (0.86/1000 CVC days) and controls (p < 0.001), but not between dCRBSI-D21rmv (4.10/1000 CVC days) and controls (p = 0.96). Our data suggest that in patients with hematological diseases or autologous SCT recipients scheduled CVC removal after 14 days does not result in a lower CRBSI incidence compared to unscheduled removal.Trial registration: DRKS00006551, 2014/09/29, retrospectively registered.

Internal jugular central venous catheterization: a focus on the procedure

Central venous catheterization (CVC) is very common procedure in the emergency department and intensive care unit. Although patients undergoing CVC may have various indications and contraindications for this catheterization, the procedure is typically similar, regardless of the route. However, site-specific precautions also exist. This report describes the overall procedure for CVC with access by the internal jugular vein. Neurologic complications such as stroke and cranial air embolism, as well as mechanical complications such as hemopneumothorax and hematoma, can occur related to the internal jugular venous approach to CVC. Clinicians should be aware of these concerns for these patients population.

Effectiveness of Using a Gelatine-Based Model in Ultrasonography-guided Jugular Central venous Catheter Placement Training: A Randomised Clinical Trial.

To evaluate the effectiveness of using a gelatine-based model, that can be prepared easily and at a low cost, compared to training without a model in ultrasonography (USG) guided internal jugular venous catheter placement training. An open-label, randomised clinical trial. (UHS) Izmir Bozyaka Training and Research Hospital, Izmir, Turkey, from 1st to 30th July 2019. Analysis was conducted with the data of 48 participants (resident physicians-RP). Group 1 (n: 26) received imaging training with USG on a human subject and then performed needle insertion training on the gelatine-based jugular vein model with the USG guidance. Group 2 (n: 22) received the same imaging training with USG but did not perform needle insertion training. Evaluation of the participants included successful long axis vein imaging time, successful in-plane needle imaging, number of changes in needle angles, the total number of punctures, successful vein puncture time, successful catheterization time, and catheterization success with the gelatine-based test manikin. Comparison of the rates of successful in-plane needle imaging (Group 1: 92.3%, Group 2: 59.1%; p = 0.006), catheterization success (Group 1: 92.3%, Group 2: 59.1%; p = 0.006), successful catheterisation time (Group 1: 77.5 sec, Group 2: 152.5 sec; p = 0.026), and total complications (Group 1: 3.8%, Group 2: 31.8%; p = 0.010) demonstrated that the model-trained RPs were significantly more successful. The study results suggest that the use of a gelatine-based model in USG-guided central jugular vein catheterisation training can be an effective method to reduce complications. Central venous catheter, Medical training, Simulation-based training, Ultrasonography.

Internal Jugular Central Venous Catheter Tip Migration: Patient and Procedural Factors.

Background: The ideal central venous catheter (CVC) tip position placement is controversial, and CVCs do not remain in a fixed position after placement. This study evaluates both patient and procedural factors which may influence CVC tip migration and subsequent catheter dysfunction. Materials and Methods: This study evaluates CVC placements at a single institution. Patient age, gender, body mass index (BMI), catheter laterality, CVC type and indication for central venous access were recorded. Catheter tip location relative to the carina was measured at time of placement and removal utilizing supine fluoroscopic imaging. Patients’ electronic medical records were reviewed for evidence of catheter dysfunction. Statistical analysis was performed utilizing odds ratios and two tailed Student’s t-test. Results: 177 patients were included (101 female; mean age 55; mean BMI 29.2). Catheter types included 122 ports, 50 tunneled large bore central venous catheters (≥9 French), and 5 tunneled small bore central venous catheters (<9 French). 127 were right sided catheters, and 50 were left sided. Left sided CVCs had a mean cranial tip migration of 3.2 cm (standard deviation ±2.9 cm) compared to 0.8 cm (standard deviation ±1.9 cm) for right sided catheters (p = 0.000008). Catheters that migrated cranially by >2 cm had more than 7× greater risk of dysfunction compared to catheters that migrated ≤2 cm (odds ratio of 7.2; p = 0.0001). Left sided CVCs were significantly more likely to have >2 cm of cranial migration (odds ratio 6.9, 95% CI 3.4–14.2, p < 0.0001) and had a higher rate of dysfunction, likely due to this cranial migration (32% vs. 4.7%; p = 0.00001). Gender and BMI were not found to be associated with catheter dysfunction or an increased odds ratio of >2 cm cranial migration. Conclusions: Left-sided CVCs migrate an average of 2.4 cm cranially more than right-sided catheters. Additionally, when migration occurs, left-sided catheters are more likely to be dysfunctional. These suggest that lower initial placement may be beneficial in left-sided catheters.

Sensorial saturation improves infants’ procedure-related pain behaviour in the cardiac intensive care unit: A quasi-experimental study

BackgroundPainful procedures are unavoidable when providing critical care to infants in intensive care units. These adverse experiences during infancy can lead to later hyperalgesia and poor neurodevelopmental outcomes. Thus, appropriate interventions are required to relieve infant pain during these procedures. ObjectivesThis study evaluated the effectiveness of sensorial saturation in reducing pain for infants during jugular central venous catheter removal procedures in intensive care units. MethodsThis study involved a quasi-experimental, repeated-measures design. Data were collected from participants sequentially recruited from April to June 2019 (control period) and July to September 2019 (experimental period). Participants included 78 infants younger than 1 year with congenital heart disease. The control group (n = 38) received a general nursing intervention using swaddling, a common child-care practice that consists of wrapping infants to restrict movements, whereas the experimental group (n = 40) received sensorial saturation using oral sugar, body massage, and verbal interaction. Infants' physiological reactions to procedural pain were measured by changes in heart rate, oxygen saturation, and respiratory rate. Infants’ procedural pain and behavioural indicators were measured using the Modified Behavioural Pain Scale. Data were analysed using descriptive statistics, independent t-tests, χ2 tests, and repeated-measures analysis of variance. ResultsCompared with the control group, the experimental group had lower heart rates (F = 53.15, p < .001), respiratory rates (F = 15.19, p < .001), and behavioural pain scores (F = 45.21, p < .001), both during and after the procedure. ConclusionsSensorial saturation can be used as a nursing intervention in infants. Given the many invasive procedures that are part of infant clinical care, sensorial saturation may be a safe analgesic alternative. The findings of this study could lead to the development of evidence-based clinical practice guidelines for the nonpharmacological management of acute pain in infants.

De Novo Central Vein Stenosis in Hemodialysis Patients Following Initial Tunneled Central Vein Catheter Placement.

Central vein stenosis (CVS) is a common complication in hemodialysis patients following tunneled central venous catheter (CVC) insertion. Little is known about its incidence, association with patient characteristics, or relationship with duration of CVC placement. We systematically evaluated central vein stenosis in hemodialysis patients receiving their first CVC exchange at a large medical center. All new hemodialysis patients underwent an ultrasound before their internal jugular tunneled CVC placement, to exclude venous stenosis or thrombosis. After the initial CVC insertion, if the patients were referred for CVC exchange due to dysfunction, a catheterogram/venogram was performed to assess for hemodynamically significant (≥50%) central vein stenosis. During a 5-year period (January 2016 to January 2021), we quantified the incidence of CVS in patients undergoing CVC exchange. We also evaluated the association of central vein stenosis with patient demographics, comorbidities, and duration of CVC dependence before exchange. During the study period, 273 patients underwent exchange of a tunneled internal jugular vein CVC preceded by a catheterogram/venogram. Hemodynamically significant CVS was observed in 36 patients (13%). CVS was not associated with patient age, sex, race, diabetes, hypertension, coronary artery disease, peripheral artery disease, or CVC laterality. However, the frequency of CVS was associated with the duration of CVC dependence (26% versus 11% for CVC duration ≥6 versus <6 months: odds ratio (95% CI), 3.17 (1.45 to 6.97), P=0.003). Among incident hemodialysis patients receiving their first tunneled internal jugular CVC exchange, the overall incidence of de novo hemodynamically significant central vein stenosis was 13%. The likelihood of CVS was substantially greater in patients with at least 6 months of CVC dependence.

The Case | Persistent fever in a hemodialysis patient

A 52-year-old man on maintenance hemodialysis through a tunneled jugular central venous catheter was referred for fever and chills and a 3 kg weight loss in the previous month. His medical history included end-stage kidney disease due to chronic pyelonephritis and 3 previous kidney transplants. He was maintained on low-dose cyclosporine and prednisone after his third allograft failed.

Safety of Bedside Placement of Tunneled Hemodialysis Catheters in the Intensive Care Unit: Translating from the COVID-19 Experience.

Background: Critically ill patients with coronavirus disease 2019 (COVID-19) and kidney dysfunction often require tunneled hemodialysis catheter (TDC) placement for kidney replacement therapy, typically under fluoroscopic guidance to minimize catheter-related complications. This entails transportation of patients outside the intensive care unit to a fluoroscopy suite, which may potentially expose many healthcare providers to COVID-19. One potential strategy to mitigate the risk of viral transmission is to insert TDCs at the bedside, using ultrasound and anatomic landmarks only, without fluoroscopic guidance. Methods: We reviewed all COVID-19 patients in the intensive care unit who underwent right internal jugular TDC insertion at the bedside between April and December 2020. Outcomes included catheter placement-related complications such as post-procedural bleeding, air embolism, dysrhythmias, pneumothorax/hemothorax, and catheter tip malposition. TDC insertion was considered successful if the catheter was able to achieve blood flow sufficient to perform either a single intermittent or 24 h of continuous hemodialysis treatment. Results: We report a retrospective, single-center case series of 25 patients with COVID-19 who had right internal jugular TDCs placed at the bedside, 10 of whom underwent simultaneous insertion of small-bore right internal jugular tunneled central venous catheters for infusion. Continuous veno-venous hemodialysis was utilized for kidney replacement therapy in all patients, and a median catheter blood flow rate of 200 mL/min (IQR: 200–200) was achieved without any deviation from the dialysis prescription. No catheter insertion-related complications were observed, and none of the catheter tips were malpositioned. Conclusions: Bedside right internal jugular TDC placement in COVID-19 patients, using ultrasound and anatomic landmarks without fluoroscopic guidance, may potentially reduce the risk of COVID-19 transmission among healthcare workers without compromising patient safety or catheter function. Concomitant insertion of tunneled central venous catheters in the right internal jugular vein for infusion may also be safely accomplished and further help limit personnel exposure to COVID-19.

Disseminated Candidiasis and Candidemia Caused by Candida palmioleophila in a Green Sea Turtle (Chelonia mydas).

Simple SummaryA sub-adult green sea turtle was rescued and treated for shell fractures on the carapace and plastron. During the first 2 months, the turtle was kept dry-docked with a placement of an intravenous catheter. Pain management, antibiotic and anthelmintic therapy, fluid therapy, human albumin, force feeding, and wound debridement were provided to manage the shell fractures and to control the infection. After 2 months of care, small budding yeasts were noted on the turtle’s blood smears. Blood cultures yielded yeast-like colonies that were later identified as Candida palmioleophila. The patient was then treated with an antifungal agent and the catheter was removed. Approximately 3.5 months later, the carapace and plastron wounds had healed. However, the turtle died at 7.5 months after rescue. The postmortem examination revealed disseminated yeast in joints, bones, brain, and lungs. This study aims to improve the veterinary medical care and, therefore, enhance the conservation of endangered sea turtles by describing a rare report of systemic C. palmioleophila infection.A sub-adult green sea turtle (Chelonia mydas) was rescued and treated for carapace and plastron shell fractures. The turtle was kept dry-docked for the first 2 months with a placement of a long-term jugular central venous catheter (CVC). Pain management, aggressive antibiotic and anthelmintic therapy, fluid therapy, force feeding, and wound debridement were provided to manage the shell fractures and control bacteremia. Human albumin was administered to treat severe hypoalbuminemia. On day 59, small budding yeasts were noted on the blood smears. Candidemia was confirmed by blood culture, as the yeasts were identified as Candida palmioleophila by the molecular multi-locus identification method. The CVC was removed, and the patient was treated with itraconazole. Although the carapace and plastron wounds had epithelized by 5.5 months after the rescue, the turtle died unexpectedly by 7.5 months. The postmortem examination revealed numerous necrogranulomas with intralesional yeasts, morphologically compatible with Candida spp., in joints, bones, brain, and lungs, suggestive of disseminated candidiasis. We describe a rare case of candidemia in the veterinary field. To our knowledge, this is the first report of candidiasis caused by C. palmioleophila in a reptile. The present results should improve veterinary medical care and, therefore, enhance the conservation of endangered sea turtle species.

Going the (social) distance: Comparing the effectiveness of online versus in-person Internal Jugular Central Venous Catheterization procedural training

BackgroundThis study compares surgical residents’ knowledge acquisition of ultrasound-guided Internal Jugular Central Venous Catheterization (US-IJCVC) between in-person and online procedural training cohorts before receiving independent in-person Dynamic Haptic Robotic Simulation training. MethodsThree surgical residency procedural training cohorts, two in-person (N = 26) and one online (N = 14), were compared based on their performance on a 24-item US-IJCVC evaluation checklist completed by an expert physician completed after training. Pre- and post-training US-IJCVC knowledge was also compared for the online cohort. ResultsNo significant change in the pass rates on the US-IJCVC checklist was found between in-person and online cohorts (p = 0.208). There were differences in the Economy of Time and Motion between in-person and online cohorts (p < 0.005). The online cohort had significant increases in US-IJCVC knowledge pre-to post-training (p < 0.008). ConclusionOnline training with independent simulation practice was as effective as in-person training for US-IJCVC.

Availability of ultrasound imaging of a guidewire parallel to the vein during internal jugular central venous catheter placement

Ultrasound verification of the guidewire traveling along the vein parallel to it and without any changes in angle has been recommended for prevention of inadvertent arterial catheterization during central venous catheter (CVC) placement. The aim of this study was to determine the availability of this parallel guidewire imaging during internal jugular CVC placement. Fifty-six adult patients undergoing cardiovascular surgery were included. The success rate of acquiring a parallel guidewire image was assessed. Logistic regression models and generalized additive models were used to identify the factors contributing to achieve parallel guidewire imaging. Among 56 patients in whom the guidewire was correctly positioned, the parallel guidewire image was acquired in 45 (80%) patients. Body mass index (crude odds ratio: 0.74 [95% confidence interval: 0.61–0.91]; p = 0.004) and distance from the puncture site to the clavicle (crude odds ratio: 1.32 [95% confidence interval: 1.11–1.58]; p = 0.002) were associated with successful depiction. The predicted probability of successful visualization was 96% (95% confidence interval: 82–99%) when the distance from the puncture site to the clavicle was 50 mm. The distance is a reliable predictor for successful visualization, and thus it should be considered when performing internal jugular CVC placement.