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"The objective of this study was to explore variability in existing training and accreditation processes for Central venous access device (CVAD) insertion" Parikh et al (2022).

Central line insertion training

Abstract:

Background: The objective of this study was to explore variability in existing training and accreditation processes for Central venous access device (CVAD) insertion among different ICUs, current practices of CVAD insertion among fellows of the College of Intensive Care Medicine (CICM) working in Australia and New Zealand (ANZ) and their recommendations for improvement.

Methods: A prospective cross-sectional web-based survey was sent via email and CICM e-Newsletter to intensivists and directors of intensive care units (ICUs) across ANZ. All responses were tabulated, post-hoc exploratory analysis using multivariable ordinal logistic regression was used and free texts were analysed thematically and summarized.

Results: 115 responses were received from various public and private ICUs from all states of ANZ. 32% of the participants did not have any accreditation process for CVAD insertion skill in their ICUs, whereas 91% of respondents revealed there were no processes to assess deskilling. Most intensivists recommended supervision, simulation, various education tools, and ultrasound training to improve training and assessment. 35% of the participants inserted 0 to 5 CVADs and more than half of the intensivists had inserted <10 CVADs in one-year period. Two-thirds of the respondents recommended inserting between 6 to 20 CVADs each year to maintain competence.

Conclusion: The study identified wide variability in current practice, training methods and accreditation process for CVAD insertion amongst intensivists and ICU trainees in ANZ. Policy makers should consider revising the current clinical practice and training policies to new policies for accreditation and ongoing assessment for CVAD insertions across ANZ ICUs.

Reference:

Parikh T, Al-Bassam W, Shehabi Y, Pakavakis A, Subramaniam A. Current practice, education, and recommendations for training of central line insertion for trainees and fellows in adult ICUs across Australia and New Zealand. Intern Med J. 2022 Jan 11. doi: 10.1111/imj.15692. Epub ahead of print. PMID: 35014135.