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Barriers to the use of ultrasound guidance in central venous catheter placement by emergency physicians in Saudi Arabia: a cross-sectional study

  • Reema M Alhussein1,*,
  • Bader A Alyahya1
  • Abdulaziz S Alashaikh1
  • Mohammed A Malabarey1
  • Khaled N Alrajhi2
  • Zohair A Al Aseri1,3

1Department of Emergency Medicine, College of Medicine and medical city, King Saud University, 11362 Riyadh, Saudi Arabia

2Department of Emergency Medicine, King Faisal Specialist Hospital and Research Center, 11564 Riyadh, Saudi Arabia

3Clinical Sciences Department and Riyadh hospital, Dar Al Uloom University, 13314 Riyadh, Saudi Arabia

DOI: 10.22514/sv.2023.035 Vol.19,Issue 5,September 2023 pp.178-185

Submitted: 09 November 2022 Accepted: 01 December 2022

Published: 08 September 2023

*Corresponding Author(s): Reema M Alhussein E-mail:


The use of ultrasound-guided central venous catheter (USG-CVC) placement is still low among emergency physicians in many countries, including Saudi Arabia, because of several inherent perceived barriers. We assessed the barriers to the use of USG-CVC placement in clinical practice among Saudis currently in training, residents and board-certified physicians and evaluated the association of these barriers with the demographic characteristics of EPs. We conducted a cross-sectional survey among all emergency physicians (EPs) practicing in Saudi Arabia who completed a residency program in emergency medicine (EM) or were board-certified emergency physicians from October to December 2018. The survey material was sent via SurveyMonkey through the Saudi Commission for Health Specialties to target EPs. Two hundred thirty-four EPs completed the survey (response rate: 66.9%), and 177 (75.6%) were males. EPs from nongovernment institutions tended to agree significantly more than EPs from government institutions with the perception that USG-CVC placement is a time-consuming process (17.9% vs. 20.3%, respectively, p = 0.022). Residents were 3.8 times more likely to perceive loss of their skill in using Ultrasound (US) for CVC placement Odds ratio (OR) = 3.806, 95% Confidence interval (CI) = 0.218–0.686, p < 0.001), 2 times more likely to believe that USG-CVC placement was not proven in randomized controlled trials (OR = 2.061, 95% CI = 0.010–0.460, p = 0.040), and 5.5 times more likely to believe that USG-CVC placement was not a cost-effective procedure (OR = 5.490, 95% CI = 0.411–0.870, p < 0.001) than board-certified EPs. Many EPs, particularly those in training, believe there are several barriers to using USG-CVC placement, including loss of skill, a lack of support of the procedure in randomized controlled trials and cost-effectiveness. This is true, although there is existing evidence and a consensus regarding the superiority of USG-CVC placement over the landmark technique. In comparison to the more experienced and well-trained board-certified EPs, residents’ confidence and skill in using USG-CVC placement may have been influenced by their training and experience.


Barriers; Ultrasound-guided central venous catheter placement; Emergency physicians; Factors; Saudi Arabia

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Reema M Alhussein,Bader A Alyahya,Abdulaziz S Alashaikh,Mohammed A Malabarey,Khaled N Alrajhi,Zohair A Al Aseri. Barriers to the use of ultrasound guidance in central venous catheter placement by emergency physicians in Saudi Arabia: a cross-sectional study. Signa Vitae. 2023. 19(5);178-185.


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