Desenvolvimento de competência para o uso da ultrassonografia como guia para realização de acesso venoso central na residência médica

Abstract

Introduction: The central venous access is an invasive procedure commonly performed in critically ill patients hospitalized in Intensive Care Units (ICU). Several studies have demonstrated that the use of ultrasound (US) to guide venous access increases the success rates of catheter placement, reduces the number of complications and improves the patient safety. In the last decades there has been an increase in the number of studies directed towards the importance of the professional competence formation in medical residency. Aim: To create a training program with active teaching-learning methods in order to develop the competence to perform ultrasound-guided internal jugular punctures. Methods: Prospective exploratory action research study involving 43 participants, 31 medical residents, nine intensive care preceptors at Onofre Lopes University Hospital and three preceptors of the cardiology discipline.. Four theoretical-practical courses were taken using a chicken breast model to simulate an ultrasound-guided venous access. All underwent pre and post-test, performance assessment by Direct Observation of Procedural Skills (DOPS) in the domains: domain 1: previous knowledge; domain 4: technical skills; and domain 10: general skills, and course evaluation. In addition to descriptive data analysis, the Cronbach’s alpha coefficient test was used to assess the reliability of responses among participants. To compare performance between residents and preceptors, we used the Kruskal-Wallis test and the Mann-Whitney test for gender comparison. Results: The evaluation models applied presented good consistency and reliability, both in the activity evaluation (α=0,894) and the DOPS (α=0,719) being the consistency and reliability almost perfect and substantial, respectively. The training model was considered adequate by 100% of the participants. There was performance predominance within the satisfactory stratum in the three domains of DOPS evaluation. Conclusion: The training model using chicken breast is feasible, well accepted and allowed to develop competence in using the ultrasound device as a guide for punctures. The DOPS evaluation was reliable and relevant and can be used to check professional authenticity in medical residency.