Concerned about inadequacy of my residency training

[Arch Guillotti]

The bottom line is that you do allow SRNAs to do central lines from time to time.

I don't.

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[Arch Guillotti]

Academic places put in A-lines way more than private practice jobs. I bet there are a ton of anesthesiologists that haven't done an a-line YEARS. They just aren't used that much in private practice because surgeons are fast, and they don't loose blood.

I agree that in private practice far fewer arterial lines are placed compared to academics. The rest of your statement is 100% BS - some of the absolute worst cases I have ever done are private practice surgeons who lost control and had horrific hemorrhage.

 

[BLADEMDA]

I place 10-15 arterial lines per week on average for big cases and high risk patients. The complication rate is extremely low for perioperative arterial lines and they can be quite useful when things turn ugly.

 

[Mman]

I do 100% supervision of 2-4 rooms at a time. I place 100% of CVPs, 100% of PNBs, 100% of epidurals. I probably do 98% of spinals, but occasionally let a CRNA do one if they really want to and I'm bored. I probably do about 75% of arterial lines, generally while they are doing the airway, but in the rest I let them do it while I'm otherwise occupied (such as putting in the CVP or what not).

 

[Arch Guillotti]

Are you letting them do u/s guided peripheral nerve blocks?

Any response Blade?

 

[epidural man]

I agree that in private practice far fewer arterial lines are placed compared to academics. The rest of your statement is 100% BS - some of the absolute worst cases I have ever done are private practice surgeons who lost control and had horrific hemorrhage.

Arch - There is no way it is BS. I moonlight at a surgery center. Since this place opened years ago, and years after I am gone - there will be exactly ZERO art lines placed. So if one worked only at this place, they would do their whole career never placing an art line.

How many surgery centers are there in the US? A LOT...and thats a lot of anesthesiologist never placing art lines.

 

[criticalelement]

I place 10-15 arterial lines per week on average for big cases and high risk patients. The complication rate is extremely low for perioperative arterial lines and they can be quite useful when things turn ugly.

what do you work at a 9000 bed hospital? Seems like you do an inordinate number of lines blocks etc.... or you may be a ****ing liar...

 

[BLADEMDA]

what do you work at a 9000 bed hospital? Seems like you do an inordinate number of lines blocks etc.... or you may be a ****ing liar...

Really? A high acuity hospital with sick patients where one covers 4 (or more) CRNAs and you think 10- 15 arterial lines are too many in one week? Clearly, you have no idea what it is like to work at my facility.

http://www.ncbi.nlm.nih.gov/pubmed/26640979

CONCLUSION:
In a large retrospective study, the authors document a very low rate of complications with arterial line placement.

 

[BLADEMDA]

Any response Blade?

CRNAs perform less than 10% of all U/S guided blocks and about 15% of all central lines. They do about 50% of the Spinals and about 90% of the Epidurals due to our high OB volume.

As in many hospitals across the South CRNAs covering the OB suite is a typical feature of the Supervisory model.

 

[BLADEMDA]

Arch - There is no way it is BS. I moonlight at a surgery center. Since this place opened years ago, and years after I am gone - there will be exactly ZERO art lines placed. So if one worked only at this place, they would do their whole career never placing an art line.

How many surgery centers are there in the US? A LOT...and thats a lot of anesthesiologist never placing art lines.

An Anesthesiologist who has only practiced at an ASC is unlikely to develop the same kinds of skills and judgement as one who has worked for 5-10 years at a high acuity facility. Like it or not that's the cold hard truth.

 

[BLADEMDA]

 

[criticalelement]

Really? A high acuity hospital with sick patients where one covers 4 (or more) CRNAs and you think 10- 15 arterial lines are too many in one week? Clearly, you have no idea what it is l
ike to work at my facility.

http://www.ncbi.nlm.nih.gov/pubmed/26640979

CONCLUSION:
In a large retrospective study, the authors document a very low rate of complications with arterial line placement.

Even with what you said I still think thats a lot of ART lines. Maybe not. if you had the vascular, thoracic neuro and spine room as your four rooms. In that case, i hope you are making a million dollars..

 

[Mman]

Even with what you said I still think thats a lot of ART lines. Maybe not. if you had the vascular, thoracic neuro and spine room as your four rooms. In that case, i hope you are making a million dollars..

10 alines a week is 2 per day. I am sure I do at least that many. Figure I might have 8-15 cases in a day so 2 or 3 a-lines isn't that many depending on the case mix.

 

[pjl]

10 alines a week is 2 per day. I am sure I do at least that many. Figure I might have 8-15 cases in a day so 2 or 3 a-lines isn't that many depending on the case mix.

Agree, that is a very reasonable number. I have days I may do 5-10 (rare) and weeks I may do 0, depending on my site assignment. An average of 10-15 sounds reasonable for even my practice, which is much less of a large tertiary site than Blade is at.


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[Arch Guillotti]

I still do about 1/2 the central lines

CRNAs perform less than 10% of all U/S guided blocks and about 15% of all central lines.

So do you do half the central lines or about 85% of them?

I don't really give a crap either way, I do think it is a little eye-opening for new residents coming out to see this sort of arrangement.

 

[Arch Guillotti]

Arch - There is no way it is BS. I moonlight at a surgery center. Since this place opened years ago, and years after I am gone - there will be exactly ZERO art lines placed. So if one worked only at this place, they would do their whole career never placing an art line.

How many surgery centers are there in the US? A LOT...and thats a lot of anesthesiologist never placing art lines.

I don't disagree with your premise about art lines and their frequency.

The assertion that all private practice surgeons are fast and don't lose blood is baloney though.

 

[BLADEMDA]

So do you do half the central lines or about 85% of them?

I don't really give a crap either way, I do think it is a little eye-opening for new residents coming out to see this sort of arrangement.

My percentages represent a range found in my practice depending on the Attending Anesthesiologist. FYI, nothing prevents a "new graduate" from doing all his/her own procedures in my practice. That means 0% for CRNAS and 100% for the new graduate in case you needed help with the math.

 

[Planktonmd]

So do you do half the central lines or about 85% of them?

I don't really give a crap either way, I do think it is a little eye-opening for new residents coming out to see this sort of arrangement.

Common let him slide...
He has done Millions of lines and Billions of Blocks so let's cut him some slack!

 

[Arch Guillotti]

Common let him slide...
He has done Millions of lines and Billions of Blocks so let's cut him some slack!

Blade knows I am only rattling his cage a little bit.

I do think an important question to ask when considering a new job is who actually does the procedures such as central lines and nerve blocks.

Although Blade's group will let a new hire do all the procedures, I would imagine that it doesn't always go over quite as easily as he claims.

 

[Mman]

Although Blade's group will let a new hire do all the procedures, I would imagine that it doesn't always go over quite as easily as he claims.

It really just depends who the CRNAs work for. If they are employed by the group, there is no discussion. If they are separately employed by the hospital then it might be somewhat of an issue.