Monday, June 28, 2010

Vas-cath exposure variability













How many vas-caths did you (the renal fellow) place during your clinical year (1 year)?
Poll results:
A. 0-5 (IR does most of these) 4 (4%)
B. 0-5 (Surgery does most of these) 2 (2%)
C. 0-5 (IM residents do most of these) 3 (3%)
D. 0-5 (combination of IR, Surgery and IM) 12 (13%)
E. 6-10 8 (9%)
F. 11-25 17 (19%)
G. 26-50 16 (18%)
H. 51-100 12 (13%)
I. 101-150 11 (12%)
J. 151-200 2 (2%)
K. >201 4 (4%)

Total Respondents- 91

Looks like there is quite a bit of variability in the number of vas-caths performed by renal fellows. I was actually a little surprised by this. Looks like the majority of folks perform anywhere between 11-100 vas-caths in a year. However, 22 (24%) fellows actually placed fewer than 5 (majority were placed by a combination of VIR, Surgery & IM residents) in a year. 4 fellows placed >201 in a year, quite an impressive number for sure. I'm fairly confident that the number of vas-caths placed by fellows is decreasing somewhat each year. I bet this is from the rise of vascular interventional radiology gobbling up all of the procedure in the hospital. I wonder what this data would look in 4-5 years from now.

6 comments:

Ala A. Sh. Ali said...

Can we know the percentage of each group in detail ? Please

Matt Sparks said...

Sorry, the poll was difficult to read. I rewrote the results.

yudi said...

I feel that Vascular Catheter insertion should be a Nephrologist procedure- most long term Vasc Caths are inserted by nephro trainees here in Malaysia. It's essential that the nephrologist be involved because it ensures that fistula creation is not neglected for the patient. We're projecting a rise in the ratio of cuffed vasc caths inserted by nephro to IR from around 40% in 2009 to 80% this year

Matt Sparks said...

Agree completely that Nephrology fellows should be competent at placing catheters, but how many should they being doing? Spending all of your time placing lines instead of doing evaluations is probably excessive. In the US, I believe it is rather uncommon to place even temporary vas-caths in private practice.

yudi said...

Not entirely sure- Pretty much impossible to survive in private practice here unless you know how to put in at least a temp vasc cath. Vascular surgeons aren't terribly interested in vasc catheters and we don't have as many IR as you. Somehow I always had the impression that the US led the world in terms of interventional procedures in nephrology.

Matt Sparks said...

I think a vast majority of graduating fellows are extremely confident in putting in temporary catheter. Cuffed catheters are a completely different story. If you are in an interventional nephrology group, then yes, but otherwise this is typically performed by vascular radiology. Thanks for the comments about Malaysia, very interesting differences between US and other countries. How many cuffed catheter does Nephro place in a year in Malaysia? fellowship vs private practice?