Assessing anatomical knowledge and confidence in central venous catheter insertion: a single-center cross-sectional study among physicians in a resource-limited setting.

BACKGROUND

Central venous catheterization (CVC) is a vital but technically demanding procedure that requires understanding of vascular anatomy to minimize complications and enhance patient safety. This study evaluates physicians' anatomical knowledge and confidence in CVC placement, focusing on the internal jugular vein (IJV), subclavian vein (SCV), and femoral vein (FV). It aims to identify critical knowledge gaps, assess their impact on procedural competency, and explore their association with complications. This research uniquely examines a low-resource setting where the reliance on anatomical landmarks is crucial due to limited ultrasound availability. The findings will inform targeted educational interventions to improve training, enhance procedural expertise, and ultimately optimize patient outcomes.

MATERIALS AND METHODS

A single-center, hospital-based descriptive cross-sectional study was conducted among 164 medical practitioners using a structured questionnaire, validated through expert review and pilot testing. The questionnaire included image-based anatomical questions and a confidence scale to assess knowledge and self-reported proficiency in CVC insertion. Participants were randomized ensuring balanced subgroup representation. Statistical analyses, including chi-square tests, effect size calculations (Cohen's and Cramer's ), and confidence intervals, were performed to evaluate associations between demographic factors, anatomical knowledge, and confidence levels.

RESULTS

The study population had near-equal gender distribution (51.22% female, 48.78% male), with participants primarily being early-career physicians. The average knowledge accuracy was 86.03% for IJV, 82.9% for FV, and 86.9% for SCV. Significant associations were observed between anatomical knowledge and job title ( = 0.03), specialty ( = 0.02), and clinical experience ( = 0.02). Gender disparities were noted, with male participants scoring significantly higher for IJV ( = 0.04) and FV ( = 0.03), although no significant difference was found for SCV ( = 0.12). Confidence levels correlated with knowledge but did not necessarily reflect procedural competence, particularly in SCV insertion. The most frequently reported challenges included difficulty in vein identification (25.6%), and insufficient training (23.2%), reinforcing the need for structured educational interventions.

CONCLUSION

This study highlights the critical need for improved anatomical education and standardized training to enhance patient safety in catheterization. It uniquely contributes to the literature by identifying challenges specific to resource-limited settings, where clinicians rely heavily on anatomical knowledge due to the limited availability of imaging technology. The study's limitations include its single-center design, self-reported data, and cross-sectional nature, limiting generalizability and long-term trend analysis. Procedural competence was not directly assessed, emphasizing the need for objective evaluations. Future studies should focus on larger, multi-center designs with direct competency assessments to better identify training gaps. Additionally, exploring advanced educational methods, such as simulation-based training and virtual reality, could offer valuable insights into improving clinical skills in environments with constrained resources. Ultimately, this study highlights substantial knowledge gaps in CVC insertion, particularly among physicians with limited procedural exposure. Addressing these gaps through structured, evidence-based training programs is essential for patient safety.