Comparison of Peripherally Inserted Central Venous Catheter (PICC) versus Central Venous Catheter (CVC) – a consecutive selection study

Background and Goal of Study: Although it is recommended that personnel with the greatest skill and experience perform airway management techniques, it is an essential skill in Intensive Care that need to be acquired by trainee as soon as possible. Some studies showed a 28% rate of complications in tracheal intubation. The aim of our study was to asses the rate and characteristics of complications concerning airway management among Intensive Care trainees in our Unit.Materials and Methods: Prospective, observational study conducted in a 40-bed ICU during a 3-month period. 15 residents (3 per year/5 years) and the staff were asked to prospectively fill a survey every tracheal intubation (TI), tracheostomy (TO) and chest tube (CT) they had performed. The items collected were: year of residency, time (day or night), urgency and hemodynamic situation. Also type of procedure, who made it, supervision, number of attemps, Cormack-Lehane grade if appropriate and the complications that might have occurred. We classified operators in groups (R1-R3, R4-R5, and staff) and number of attemps (u22642 and >3).Results and Discussion: 54 airway procedures were done: 36 (66,7%) TI, 13 (24,1%) TO and 5 (9,3%) CT. 6 (11,1%) were done during night time (0-9 hs) and 34 (63%) during an emergency situation. R1-R3 made 36 (66,7%), R4-R5 15 27,8%) and staff 3 (5,6%). 17 (31,5%) patients were hemodynamically unstable. 11 (20,4) had any kind of anatomical difficulty. Complication occurred in 6 (11,1%) situation. In general, there was no association between complication and anatomical difficulty (p=0,91), who performed the technique (p=0,5), supervision (p=1), emergency and hemodynamic situation (p=0,66 and p=1). Concerning TI, complications did not associated with Cormack grade (p=0,57) but to > 3 attempts (p=0,005).Conclusions: Younger trainees should be encouraged to performed airway management techniques regarding the time of the day, hemodynamic situation, anatomic difficulty and emergency situations.Although supervision had no statistic significance in this study, probably due to a small sample size, it is fundamental for education and patient safety.A limit of 2 attempts per operator is recommended to avoid complications.References: 1) Jaber S et al. Crit Care Med 2006; 34:2355-23612) Roux D et al. Crit Care Med 2014; 42:886-895