Background: In the academic trauma unit during initial evaluation and resuscitation of trauma
victims, central venous catheters are often placed by multiple operators. There are few data
on compliance with accepted, standard sterile practices during such procedures.
Methods: Prospective data were tabulated from video capture of 144 consecutive central venous
catheterizations in a trauma resuscitation unit, during peak hours, by a team of trained
video technicians. The physicians were surgical and emergency medicine residents. The number
of primary operators (trainees) and secondary operators (mentors) for each line was recorded
from the video analysis, as well as physician adherence to the use of maximum barrier precautions
(MBP; sterile gown, gloves, full operative drape, cap, and mask). Procedures were stratified
by level of urgency: Emergent (n = 7), semi-emergent (n = 20), and elective (n = 113).
Results: The subclavian vein was used for 73% of the elective catheter placements. For elective
central venous catheters, 99 of 113 primary operators (88%) observed MBP, whereas only 31
of 45 secondary operators (69%) did so (p ≤ 0.01). Among the 45 elective central venous catheters
placed with a secondary operator, there were four instances of frank contamination (9%).
Conclusions: Secondary operators, typically trauma surgery attendings, trauma/critical care fellows, or senior surgical residents, function as mentors in academic institutions and act as role models.
Secondary operators participated in many of the studied cases, yet failed to demonstrate consistent
use of MBP. In elective central venous catheter placement, those where there was the greatest
opportunity to follow MBP, we observed a statistically significant difference in compliance rate
between the primary and secondary operators. The study suggests the need to address the performance
of the secondary operators and to educate them, as although they may be technically experienced
in placing central venous catheters, they may comply less consistently with MBP.
