Yuan Christina M, Oliver James D, Little Dustin J, Narayan Rajeev, Prince Lisa K, Raghavan Rajeev, Nee Robert
1 Nephrology SVC, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA.
2 San Antonio Kidney Disease Center Physicians Group, San Antonio, TX, USA.
J Vasc Access. 2019 Sep;20(5):507-515. doi: 10.1177/1129729818820231. Epub 2018 Dec 28.
Nephrologists are placing fewer non-tunneled temporary hemodialysis catheters. Requiring competence for nephrology fellow graduation is controversial.
Anonymous, online survey of all graduates from a single, military nephrology training program (n = 81; 1985-2017) and all US Nephrology program directors (n = 150).
Graduate response and completion rates were 59% and 100%, respectively; 93% agreed they had been adequately trained; 58% (26/45) place non-tunneled temporary hemodialysis catheters, independent of academic practice or time in practice, but 12/26 did ⩽5/year and 23/26 referred some or all. The most common reason for continuing non-tunneled temporary hemodialysis catheter placement was that it is an essential emergency procedure (92%). The single most significant barrier was time to do the procedure (49%). Program director response and completion rates were 50% and 79%, respectively. The single most important barrier to fellow competence was busyness of the service (36%), followed by disinterest (21%); 55% believed that non-tunneled temporary hemodialysis catheter insertion competence should be required, with 81% indicating it was an essential emergency procedure. The majority of graduates and program directors agreed that simulation training was valuable; 76% of programs employ simulation. Graduates who had simulation training and program directors with ⩽20 years of practice were significantly more likely to agree that simulation training was necessary.
Of the graduate respondents from a single training program, 58% continue to place non-tunneled temporary hemodialysis catheters; 55% of program directors believe non-tunneled temporary hemodialysis catheter procedural competence should be required. Graduates who had non-tunneled temporary hemodialysis catheter simulation training and younger program directors consider simulation training necessary. These findings should be considered in the discussion of non-tunneled temporary hemodialysis catheter curriculum requirements.
肾脏病医生放置非隧道式临时血液透析导管的情况越来越少。要求肾脏病专科住院医师毕业时具备相关能力存在争议。
对一个单一的军队肾脏病培训项目的所有毕业生（n = 81；1985 - 2017年）和所有美国肾脏病项目主任（n = 150）进行匿名在线调查。
毕业生的回复率和完成率分别为59%和100%；93%的人同意他们接受了充分的培训；58%（26/45）放置非隧道式临时血液透析导管，这与学术实践或从业时间无关，但26人中有12人每年放置不超过5次，26人中有23人会转诊部分或全部患者。继续放置非隧道式临时血液透析导管的最常见原因是它是一项必要的急救操作（92%）。唯一最重要的障碍是进行该操作的时间（49%）。项目主任的回复率和完成率分别为50%和79%。专科住院医师能力的唯一最重要障碍是科室繁忙（36%），其次是缺乏兴趣（21%）；55%的人认为应该要求具备非隧道式临时血液透析导管插入能力，81%的人表示这是一项必要的急救操作。大多数毕业生和项目主任都认为模拟培训很有价值；76%的项目采用模拟培训。接受过模拟培训的毕业生和从业年限不超过20年的项目主任更有可能认为模拟培训是必要的。
在一个单一培训项目的毕业生受访者中，58%继续放置非隧道式临时血液透析导管；55%的项目主任认为应该要求具备非隧道式临时血液透析导管操作能力。接受过非隧道式临时血液透析导管模拟培训的毕业生和较年轻的项目主任认为模拟培训是必要的。在讨论非隧道式临时血液透析导管课程要求时应考虑这些发现。
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