Using central venous pressure waveform to confirm the placement of an internal jugular central venous catheter in the intensive care unit.

BACKGROUND: A mobile chest X-ray is traditionally performed to confirm the position of an internal jugular central venous catheter (CVC) after placement in the intensive care unit (ICU). Using chest radiography to confirm CVC position often results in delays in authorising the use of the CVC, requires the deployment of additional human resources, and is costly. OBJECTIVE: This study aimed to determine the feasibility and accuracy of using the central venous pressure (CVP) waveform to confirm the placement of internal jugular CVCs. METHODS: This retrospective study was conducted in a single quaternary ICU over a 6-month period. We included adult patients who had internal jugular CVC inserted and CVP transduced as part of their routine care in the ICU. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CVP waveform analysis in confirming the position of internal jugular CVC relative to chest radiography were calculated. RESULTS: A total of 241 internal jugular CVCs were inserted (in 219 patients, 35.6% female), and the CVP waveform was assessed. In 231 cases, this suggested adequate placement in a central vein, which corresponded with a correct position on subsequent chest X-ray. On six occasions, the CVP waveforms were interpreted as suboptimal; however, on chest X-rays, the CVCs were noted to be in a suitable position (sensitivity: 97.5%). Four suboptimal CVP waveforms were obtained, and they correctly identified CVC malposition on subsequent chest X-ray (specificity: 100%). The average time from CVC insertion to radiological completion was 118 minutes. CONCLUSION: CVP waveform analysis provides a feasible and reliable method for confirming adequate internal jugular CVC position. The use of chest radiography can be limited to cases where suboptimal CVP waveforms are obtained.

Medical emergency team training: needs assessment, feedback and learning objectives.

BACKGROUND: There are no published studies assessing learning needs and attitudes prior to attending a medical emergency team (MET) education programme. AIMS: To conduct a learning needs assessment of MET education programme participants to assess what technical and non-technical skills should be incorporated. METHODS: All participants in a MET education programme over a 12-month period were invited to complete a self-administered electronic survey. Participants were ICU team members (intensive care registrars and nurses) and medical registrars. Responses were captured through a 5-point Likert scale. RESULTS: There were 62 responses out of 112 participants (55% response rate). Most participants either agreed or strongly agreed that MET training was valuable (59 respondents) and should be multidisciplinary (61 respondents). ICU team members were more likely to select 'Management of End-of-Life Care' (72% compared with only 16% of medical registrars, P < 0.05) as an important learning objective. Non-technical skills such as 'Task Management' (67% compared with 37%, P < 0.05) and 'Team Communication' (79% compared with 32%, P < 0.05) were also more likely to be selected by ICU team members. Nursing team members were more likely to select 'Approach to Common MET Calls' (100% compared with 50% of medical team members, P < 0.05). CONCLUSIONS: MET education programme participants overwhelmingly feel that training should be multidisciplinary. However, there are disparities between the perceived learning needs of medical and nursing personnel, and between intensive care team members and medical registrars, which may impact on the design and implementation of a multidisciplinary education programme.

Structure-activity delineation of quinones related to the biologically active Calothrixin B.

Quinones such as Calothrixins A and B display a range of biological properties. As part of our ongoing studies to elucidate the mechanism of action of the Calothrixins, several related quinones were synthesized and tested for biological activity. The results of the structure-activity relationship (SAR) studies are reported here.