Development of objective performance metrics for ultrasound-guided internal jugular vein cannulation on behalf of the College of Anaesthesiologists of Ireland and observation of scores amongst novice and experienced operators

Abstract

Background: Ultrasound-guided, internal jugular venous (IJV) cannulation is a core technical skill for anaesthesiologists and intensivists.

Objectives: At a modified Delphi panel meeting, to define and reach consensus on a set of objective ultrasound-guided IJV cannulation performance metrics on behalf of the College of Anaesthesiologists of Ireland (CAI). To use these metrics to objectively score video recordings of novice and experienced anaesthesiologists.

Design: An observational study.

Setting: CAI, March to June 2016 and four CAI training hospitals, November 2016 to July 2019.

Participants: Metric development group: two CAI national directors of postgraduate training (specialist anaesthesiolgists), a behavioural scientist, a specialist intensivist and a senior CAI trainee. Scoring by two blinded assessors of video recordings of novice ( n = 11) and experienced anaesthesiologists ( n = 15) ultrasound-guided IJV cannulations.

Main outcome measures: A set of agreed CAI objective performance metrics, that is, steps, errors, and critical errors characterising ultrasound-guided IJV cannulation. The difference in performance scores between novice and experienced anaesthesiologists as determined by skill level defined as being below or above the median total error score (errors plus critical errors): that is, low error (LoErr) and high error (HiErr), respectively.

Results: The study identified 47 steps, 18 errors and 13 critical errors through six phases.Variability was observed in the range of total error scores for both novice (1 to 3) and experienced (0 to 4.5) anaesthesiologists. This resulted in two further statistically different subgroups (LoErr and HiErr) for both novice ( P = 0.011) and experienced practitioners ( P < 0.000). The LoErr-experienced group performed the best in relation to steps, errors and total errors. Critical errors were only observed in the experienced group.

Conclusion: A set of valid, reliable objective performance metrics has been developed for ultrasound-guided IJV cannulation. Considerable skill variability underlines the need to develop a CAI simulation-training programme using these metrics.