A Survey of Training for Temporary Hemodialysis Catheter Insertion During Nephrology Fellowship in Canada: An Update

摘要

English French Background: Controversy exists as to whether the insertion of temporary hemodialysis catheters (THDCs) should remain a mandatory requirement of nephrology fellowship training in Canada. A survey conducted by our group in 2012 showed that many nephrology trainees reported inadequate training to achieve procedural competence. Objective: To determine the current practices and training of the insertion of THDCs in nephrology fellowship programs in Canada and how this has evolved since 2012. Design: A survey study was designed comprising the following sections: demographics, details regarding the number and types of THDCs inserted within the past 6 months of fellowship training, adherence to sterile techniques, the use of ultrasound guidance during THDC insertion, training for THDC insertion received before and during nephrology fellowship, and self-perceived adequacy of training and competence in THDC insertion. Setting: The survey was distributed by e-mail in May 2018 either directly or through Canadian nephrology training programs. Participants: Current trainees of Canadian adult nephrology training programs. Measurements: Descriptive statistics were used to analyze the summarized data. The means and interquartile ranges (IQRs) were used to summarize the number of THDC insertions performed, and the categorical data, including data on training and self-perceived competency, were reported using frequencies and percentages. A chi-squared test was used to evaluate the relationship between those who received simulation-based training and self-perceived confidence in either internal jugular or femoral catheter insertion. Methods: An online survey, available in both English and French, was distributed to all adult nephrology trainees in Canada in May 2018 either directly or through their respective programs. Results: Completed surveys were received from 46 of 136 nephrology trainees across Canada (34%). Of those who responded, the median (IQR) number of combined femoral and/or internal jugular THDCs inserted in the past 6 months of fellowship training was 3 (1-6). Eight respondents (17%) indicated that they had not inserted a THDC in the past 6 months. However, only 7 of 42 respondents (17%) indicated that they did not feel competent or adequately trained to perform either femoral or internal jugular THDC insertion. Limitations: Limitations of the study include participation of trainees at different stages of their training. Many trainees indicated that it was not a requirement to keep a formal log of their procedures performed and likely had recall bias when reporting their procedure details. Conclusions: Nephrology fellows in Canada are performing fewer THDC insertions compared to 2012 but report higher levels of self-perceived competence and better training. This may be as a result of significantly more simulation-based training. Our data suggest that training to procedural mastery using simulation-based techniques may be a path to ensuring adequate training for THDC insertion despite fewer procedures being performed during training. Abrégé Contexte: Une controverse existe à savoir si l’insertion de cathéters d’hémodialyse temporaires (CHT) devrait demeurer une exigence de la formation des néphrologues au Canada. Une enquête menée par notre groupe en 2012 montrait que plusieurs stagiaires en néphrologie jugeaient leur formation insuffisante pour l’acquisition de compétences techniques. Objectifs: Faire état des pratiques et de la formation actuelles en matière d’insertion de CHT dans les programs canadiens de stages en néphrologie, et témoigner de l’évolution de la situation depuis 2012. Conception de l’étude: L’étude, sous forme de sondage, a été con?ue en incluant les éléments suivants: les données démographiques, les détails quant au nombre et au type de cathéters insérés au cours des six derniers mois de la formation, l’observance des techniques d’asepsie, le recours à l’échoguidage pendant la procédure, la formation re?ue sur l’insertion de CHT avant et pendant le stage en néphrologie, et l’auto-évaluation de l’adéquation de la formation et des compétences individuelles en insertion de CHT. Type d’étude: Un sondage distribué en mai 2018 par courrier électronique, directement ou par l’entremise des programs de formation en néphrologie. Sujets: Les stagiaires actuels des programs canadiens de formation en néphrologie adulte. Mesures: Des statistiques descriptives ont été utilisées pour analyzer les données agrégées. Les moyennes et les écarts interquartiles (EIQ) ont été employés pour résumer le nombre d’insertions de CHT. Les données catégorielles, y compris les données sur la qualité de la formation et la compétence per?ue, ont été rapportées en fréquences et en pourcentages. Enfin, un test xsup2/sup a évalué le lien entre la compétence individuelle per?ue quant à l’insertion d’un cathéter dans la jugulaire interne ou dans la veine fémorale et le fait d’avoir ou non re?u une f