Learning curve of ultrasound-guided percutaneous central venous port placement in children

Abstract

Background: Although percutaneous central venous port (CVP) placement can be quickly performed using minimally invasive surgery, short- and long-term complications can occur. Beginner pediatric surgeons must overcome learning curves influencing operative time and complication rates. However, few studies have been conducted on the learning curve of ultrasound-guided percutaneous CVP placement. This study analyzed the progress, results, complications, and learning curve of ultrasound-guided percutaneous CVP placement in children performed by a single beginner pediatric surgeon.

Methods: Data from 30 children who underwent ultrasound-guided percutaneous CVP placement were reviewed. The patient characteristics, procedure indications, access veins, operator positions, operative times, and complication rates were analyzed.

Results: Cumulative sum analysis revealed two stages in the learning curve: stage 1 (initial 15 cases) and stage 2 (subsequent cases). There was a correlation between the number of cases and operative time (Pearson correlation = -0.499, p = 0.005); the operative time was significantly longer in the first than in the second stage (p = 0.007). Although surgical complications occurred more frequently in the early (26.7%) than in the late stage, it was not significantly different between the two stages (p = 0.1). During the study period, the operative time was significantly reduced owing to the change in the operator's position from the patient's right side to the patient's head (p = 0.005).

Conclusions: Ultrasound-guided percutaneous CVP placement was a safe surgery that allowed a beginner pediatric surgeon to overcome the learning curve after only 15 cases and involved a relatively small number of complications compared with other pediatric surgeries. Additionally, the suitable position of the operator affected the surgical outcomes.