Procedure credentialing:
We are expected to do the following procedures:
Central venous catheters (CVL), vascaths (VC) for hemodialysis access and arterial lines. We often also insert introducers/cordis (for large bore access in massive blood loss, insertion catheter for SGC) and trialysis catheters (vascath with an additional port for medications). These are inserted under sterile conditions using the seldinger technique.
Advanced Airways: Intubations (insertion of ETT, LMA)
Other (OPTIONAL): Thoracentesis, Chest Tube Placement, paracentesis
In order to become credentialed for each procedure, you must:
Observe 3 procedures; document and complete “request to begin procedures”
Perform 10 proctored procedures with physician signature (Keep MRNs of patients you perform procedure on and scan in all your documents just in case hospital loses them in future)
Complete new DOP form with only the new procedure you are requesting
Submit protected procedures packet to credentialing committees
** please see the documents below for more detailed information**
Procedural Training
Getting Sterile - how to put on sterile gloves
know what you’re looking at on ultrasound
Above: a vein and artery on ultrasound. Veins are usually larger with hypo-echoic walls; when you press down on it, it will easily collapse. Arteries, in contrast, are going to be smaller with sometimes hyper-echoic walls (Think PAD). Arteries also pulsate when you push down on them with slight pressure (push down too much and you will obstruct all flow).
How to Insert a CVL
Intubations
You will complete airway credentialing/training during mentorship. However, you will begin the process starting from day one of your program
Requirements to begin proctored intubations:
observe 3 intubations, keep for your records.
Complete basic airway training ( this will be scheduled for you during your monthly SIM)
Proctored Intubations:
once you have observed 3 intubations, and had basic airway training- you can now begin your proctored intubations.
ideally, your intubations will begin with patients without difficult airway predictors or major physiologically difficult patients. Your preceptor should be able to identify patients to begin this process, please let them know once you are ready to begin intubating.
Requirements for FINAL airway credentialing:
20 total intubation procedures ( 10 must be in the ICU setting)
5 LMA insertions
Difficult Airway Course Certificate
this will be scheduled during your phase 1 training, either in person or online course.
Once the above items have been obtained and all documentation and forms are completed, you will submit to credentialing offices ( please see above documents for more information)
Final Airway Check off with the airway team ( internal process)
You are not able to do independent intubations until you have been checked off by our airway team
goal check off is 2 months after your vet check ( during block 7/8 of residency)
It will be done with a simulation mannequin; you will get a proctored procedure review and go through airway scenarios.