The use of ultrasound as an adjunct to peripheral venous cannulation by junior doctors in clinical practice

Abstract

Purpose: There is little consensus on the role of training in bedside ultrasound skills for medical students or junior doctors early in their careers.

Methods: We trained 20 Foundation Year 1 doctors in the use of ultrasound as an adjunct to peripheral venous cannulation and following an assessment of competence gave them access to an ultrasound machine to assist with difficult cannulations in their clinical practice. Self-reported confidence and competence were assessed using pre- and post-training questionnaires, with competence objectively assessed immediately post-training and at one and three months follow up. Clinical use of ultrasound was studied over three months.

Results: Improvements in self-reported confidence and competence were observed post-training and retained at three months. 85% (17/20) of participants were objectively assessed as competent immediately post-training, with retention of competence demonstrated in 80% (16/20) and 75% (15/20) at one and three months, respectively. There were 33 separate uses of ultrasound during the three month study period with a 73% (24/33) success rate and no adverse incidents.

Conclusions: We suggest that doctors in their first post-graduate year can be trained in the use of ultrasound as an adjunct to peripheral venous cannulation, retain the skill over time and use it safely in their clinical practice.

Acknowledgements

The authors would like to acknowledge Sonosite Inc. who sponsored the study by providing an ultrasound machine for clinical use, Blackpool Teaching Hospitals NHS Foundation Trust Research & Development Committee who also sponsored the study, Prof Ravi Gulati and Prof Morris Gordon who generously provided peer review of study design, staff at the Blackpool Teaching Hospitals Simulation and Skills Centre who provided logistical support for training and all participating FY1 doctors and patients who donated their time and enthusiasm.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Glossary

Point of Care Ultrasound: Is defined as ultrasonography brought to the patient and performed by the provider in real time. Point-of-care ultrasound images can be obtained nearly immediately, and the clinician can use real-time dynamic images (rather than images recorded by a sonographer and interpreted later), allowing findings to be directly correlated with the patient's presenting signs and symptoms. Point-of-care ultrasonography is easily repeatable if the patient's condition changes. It is used by various specialties in diverse situations allowing findings to be directly correlated with the patient's presenting signs and symptoms and may be broadly divided into procedural, diagnostic, and screening applications.

Point-of-Care Ultrasonography, Christopher L. Moore, M.D., and Joshua A. Copel, M.D. N Engl J Med 2011; 364:749-757 February 24, 2011. DOI: 10.1056/NEJMra0909487

Notes on contributors

Dr Ryan Breslin, MB BChir, MA, PGCert, is currently a registrar in anaesthesia at the Royal Adelaide Hospital and Clinical Lecturer in Simulation at the University of Adelaide, South Australia. He conceived, designed and co-ordinated the study whilst a Foundation Year 2 doctor at Blackpool Teaching Hospitals NHS Foundation Trust.

Dr Jason Cupitt, BSc, MB ChB, FRCA, FFICM, is a consultant in anesthesia and intensive care at Blackpool Teaching Hospitals NHS Foundation Trust. He supervised the study, contributed to study design and delivered the training to participating doctors.

Dr Karen Collins, BSc, MB ChB, MCAI, is a registrar in anaesthesia at St Mary's Hospital, London. She acted in capacity of independent assessor of participating doctors whilst a registrar in anaesthesia and intensive care at Blackpool Teaching Hospitals NHS Foundation Trust.

Additional information

Funding

The ultrasound machine used in the clinical phase of the study was kindly supplied on loan by Sonosite Inc. Blackpool Teaching Hospitals NHS Foundation Trust Research and Development Committee sponsored the study financially with a grant of £1368.83.