Procedure Numbers

[zeloc]

How many arterial and central lines are you getting to do on different rotations, eg MICU? Are they mostly done by interns or residents and how many do you usually do by the end of residency?

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[docrocmayo]

PGY-3 starting cardiology fellowship in jULY 2009.
my census.
art line 1
central line- IJ 4
Femoral 0
Subclavian 0
intubation 0
Pap smears- 25!
I dont mean to boast about these numbers, but to be honest this is where I am at !

 

[Geri_Gal]

Great thread. PGY2. Interested in Pulm/CC.

art line - 5
central line - IJ 7
Femoral - 0
Subclavian - 1 attempt
intubation - 0
digital rectal exam - 236

 

[souljah1]

PGY3

Subclavian CVC: 3
US guided IJ CVC: 15-20
Femoral CVC: 5-10
Arterial Line: 20-25
Thoracentesis: 8-10
Paracentesis: 15-20
Lumbar Puncture: 8-10

 

[internalmed1111]

Great thread. PGY2. Interested in Pulm/CC.

digital rectal exam - 236

fun times

 

[zeloc]

Thanks for the replies. For the first 2 posts, are these numbers typical?

 

[Geri_Gal]

For my program, yes. I've been pretty assertive with procedures, too.
Patients rarely get art lines in the MICU. Ultrasound guided IJ's are placed only for CVP monitoring. Femoral lines are only placed during a code or emergent situation, as they are generally frowned on as a "dirty" line. I think one person in my residency class has been signed off on subclavians. Internists are not allowed to intubate independently...maybe a resident could intubate if they asked the anesthesia resident to let them, but overall, we aren't given much education in airway management -- even with mask ventilation.

As a resident, now that I can independently do most procedures, I often need to let the intern do IJ's or art lines to ensure they become signed off to do them independently. Thus - I haven't done as many procedures as a resident.

The culture of each residency program differs...so questions about procedural numbers are great to ask.

 

[bigtuna]

These numbers vary widely among programs. I logged over 75 lines as as IM resident but I was assertive about doing them because I was going into Pulm.

If you are interested at being competent at these procedures you should ask the residents about them when you interview but realize that the vast majority of IM trained individuals do not do any of them once they finish training.

 

[Polish Farmer]

MS 4

Art lines: 1
Subclavian: 1 (kinna - wired a pacer in with fluoro help)
IJ: 0
Femoral: 0
Thoracentesis: 3
Paracentesis: 8
LP: 9 (on sleeping children)
Intubation: 2
Paps: 3
DREs: 2,563

 

[Hernandez]

It's highly program dependent, my program is more hands on except with para's, thoras, and chest tubes.

PGY-2
Central lines - 35
-U/s IJs - 25
-fems - 8
-Subclavians - 2 - these will what I be focusing next
Art Lines - 20
ABG draws - 30+
Intubation - 15 this year, 20 total so far
LP - 4
Thora - 4
Para - 5
NGs- 40+
Foley's - 4
Chest tubes - 0
Paps - too damn many
DREs - too damn many

 

[blabbyblab]

MS 4

Art lines: 1
Subclavian: 1 (kinna - wired a pacer in with fluoro help)
IJ: 0
Femoral: 0
Thoracentesis: 3
Paracentesis: 8
LP: 9 (on sleeping children)
Intubation: 2
Paps: 3
DREs: 2,563

We should switch rotations so I can do taps and you can do lines and tubes.

MS4
Art Lines: 7 or 8, plus quite a few blood gases. started trying ultrasound on these, makes them go pretty smoothly
Subclavian: 6
IJ: 2
Femoral: 0 (a couple of fem artery sticks)
Thoracentesis: 0
Paracentesis: 0
LP: 1
Intubations: 6 or 7
Paps: more than I care to remember
Colonoscopy: 10
EGD: 2
DRE:
Then NGs, lac repairs, abscesses, etc..

 

[souljah1]

I don't know if the poster was asking med students how many procedures they get, but rather residents - so they can get a sense of their program with respect to others.

A medical student saying that he/she did a colonoscopy just seems hilarious to me. My imagination has a med student with a yellow gown holding the scope and trying to drive while the television that every one is watching shows a lens shoved up against bowel wall....count it.

 

[LanceArmstrong]

My count...PGY2

thoracentesis...3
paracentesis...5-10
femoral....4
IJ.....1
subclavian....0
PAP.....0
LP......1
DRE.......100-500
NGT........100-500
ABG........1000+
Art line......0
blood draw....1000+
IV line ....100+

In my MICU rotation on night I would have to do at least 5, and as many as 15 ABG's every night

 

[RTrain]

I'm intrigued by the differing culture on location of CVC placement - seems like most folks do a lot more IJs than SCs, but I've had the opposite experience. Also, bedside para and thora isn't really encouraged by our program, it's preferred to send patients to IR, so you have to be pretty aggressive to get those. Weird.

I'm a PGY3 -

Subclavian CVC: 12-15
IJ CVC: 4
Femoral CVC: 2 (in codes)
Arterial line: 25ish
Paracentesis: 3
Thoracentesis: 5
LP: 4
Intubation: 7 I think
Pap: TNTC
DRE: TNTC
NGT: 40ish in my former life as a surgery resident; placed by RNs at my current program