How many supervised CVC insertions to reach competence
Background: Training is essential for the safe and uncomplicated placement of hemodialysis catheters. This study explores the learning curve of this procedure.
Methods: In this prospective study, 60 patients who needed emergency hemodialysis without vascular access were included. All catheters were placed under ultrasound guidance. One nephrologist was included in each two groups, one to be consisted of a junior, and one to be consisted of a senior. Learning curves were created using the cumulative total methodology and receiver operating characteristic curve analyses.
Results: The patients’ mean age was 67.92 ± 14.23 years. The mean catheter insertion time of the senior nephrologist was significantly shorter than that of the junior. According to cumulative total analysis, the junior group’s maximum learning point overlaps with patient 22. When the confidence intervals of the study durations of both groups were examined, they overlapped in the 95% confidence interval starting from the 19th patient. When the mean catheter insertion time of the senior and the mean of the last 12 patients of the junior were compared, there was no significant difference between them (F = 15.827, P = .092). The receiver operating characteristic curve analysis showed a cutoff value of 320 seconds for the junior group compared with the senior group, indicating an overlap in case 22 for the junior nephrologist.
Conclusion: This study suggests that 22 catheter insertions under the supervision of a senior nephrologist are needed to complete the learning curve for a junior nephrologist. If the number of nephrologists at the center is limited, safe catheter insertion may be allowed after 19 insertions.
Karaaslan T, Ayaloglu J, Kocaaslan C, Uysal O, Kuzgun GS, Odabas AR, Ecder ST, Ecder SA. Learning Curve for Temporary Hemodialysis Catheter Placement. Transplant Proc. 2023 Apr 21:S0041-1345(23)00159-8. doi: 10.1016/j.transproceed.2023.01.034. Epub ahead of print. PMID: 37088615.