Competency | Mandatory, no. (%) | Optional, no. (%) | Superfluous, no. (%) |
---|---|---|---|
General competencies | |||
Know which probe(s) to use and probe orientation | 25/26 (96)* | 1/26 (4) | 0 |
Basic knobology (depth/gain) | 26/26 (100)* | 0 | 0 |
Appropriate infection prevention and control measures | 18/26 (69) | 5/26 (19) | 2/26 (8) |
Appropriate sheathing of transducers for real-time guidance | 20/25 (80)* | 2/25 (8) | 3/25 (12) |
Recognizes limitations (e.g. when procedure cannot be performed or should be performed by a more experienced proceduralist) | 25/26 (96)* | 1/26 (4) | 0 |
Able to correlate findings on ultrasound with surface anatomy | 19/26 (73)* | 5/26 (19) | 2/26 (8) |
Thoracentesis | |||
Can identify the spine sign (e.g. vs. mimickers and false positives of pleural effusion such as drop out artifact) | 19/26 (73)* | 7/26 (27) | 0 |
Characterization of pleural effusion (septations/etc.) | 18/26 (69) | 8/26 (31) | 0 |
Assessment to include probe sliding/two planes | 20/25 (80)* | 3/25 (12) | 2/25 (8) |
Assessment to include deep breaths (lung movement) and diaphragm movement | 14/26 (54) | 10/26 (38) | 2/26 (8) |
Can identify location of diaphragm/intra-abdominal organs/lung tip | 25/26 (96)* | 1/26 (4) | 0 |
Ruling out vasculature (e.g. intercostal vessels) | 11/26 (42) | 14/26 (54) | 1/26 (4) |
Indirect guidance | 25/26 (96)* | 1/26 (4) | 0 |
Direct real-time guidance† | 1/26 (4) | 8/26 (31) | 17/26 (65) |
Assessing for pneumothorax pre- and post- | 7/26 (27) | 12/26 (46) | 7/26 (27) |
Sinusoidal sign | 0 | 5/25 (20) | 20/25 (80)* |
Pleural effusion size estimation | 1/25 (4) | 12/25 (48) | 12/25 (48) |
Paracentesis | |||
Can identify abdominal free fluid | 25/26 (96)* | 1/26 (4) | 0 |
Assessment to include probe sliding/two planes | 18/26 (69) | 7/26 (26) | 1/26 (4) |
Assessing for location of structures to avoid (liver, spleen, bladder, kidney, bowel) | 24/26 (92)* | 2/26 (8) | 0 |
Assessment to include compression to ensure depth of fluid collection remains sufficient | 17/26 (65) | 8/26 (31) | 1/26 (4) |
Ruling out vasculature (e.g. inferior epigastrics/collaterals) | 20/26 (77)* | 6/26 (23) | 0 |
Indirect guidance | 26/26 (100)* | 0 | 0 |
Real time guidance (either in-plane or out-of-plane)† | 1/26 (4) | 8/26 (31) | 17/26 (65) |
Real-time in-plane guidance | 0 | 4/25 (16) | 21/25 (84)* |
Real-time out-of-plane guidance | 0 | 4/25 (16) | 21/25 (84)* |
Recognizes mimickers of free fluid (e.g. intraluminal fluid, perinephric fat) | 22/25 (88%)* | 3/25 (12) | 0 |
Central venous catheterization (CVC) | |||
Can differentiate between artery vs. vein | 26/26 (100)* | 0 | 0 |
Assessment to include ruling out deep vein thrombosis (in the access site vein, not thrombosis in the legs) | 15/26 (58) | 10/26 (38) | 1/26 (4) |
Identify appropriate insertion site based on anatomy (not just where vein is largest, but if location is too low and at high risk of pneumothorax) | 22/26 (85)* | 4/26 (15) | 0 |
Can identify underlying lung (for internal jugular and subclavian sites) | 20/26 (77)* | 5/26 (19) | 1/26 (4) |
Creep technique for all real-time guidance maneuvers | 17/25 (68) | 7/25 (28) | 1/25 (4) |
Real time guidance for internal jugular CVC | 24/26 (92)* | 2/26 (8) | 0 |
Internal jugular CVC: either in-plane or out-of-plane | 17/25 (68) | 7/25 (28) | 1/25 (4) |
Internal jugular CVC: in-plane | 2/24 (8) | 14/24 (58) | 8/24 (33) |
Internal jugular CVC: out-of-plane | 7/24 (29) | 8/24 (33) | 9/24 (34) |
Subclavian CVC: real-time guidance | 10/25 (40) | 9/25 (36) | 6/25 (24) |
Subclavian CVC: indirect guidance | 4/25 (16) | 12/25 (48) | 9/25 (36) |
Femoral CVC: real-time guidance | 22/26 (85)* | 4/26 (15) | 0 |
Femoral CVC: indirect guidance† | 7/24 (29) | 8/24 (33) | 9/24 (38) |
Assessment to include confirming location of wire intra-vein with ultrasound | 25/26 (96)* | 1/26 (4) | 0 |
Assessment to include confirming catheter is intra-vein with ultrasound | 10/26 (38) | 11/26 (42) | 5/26 (19) |
Assessing for pneumothorax pre- and post- | 6/25 (24) | 11/25 (44) | 5/25 (2) |
Saline flush test | 3/26 (12) | 10/26 (38) | 13/26 (50) |
Assessing for direction of catheter towards superior vena cava | 2/26 (8) | 7/26 (27) | 17/26 (65) |
Performs bicaval view to visualize the catheter tip | 1/25 (4) | 4/25 (16) | 20/25 (80)* |