AS9.1-2 | Intravenous Access and Central Venous Access in Simulation — Summary & Reflection

KEY TAKEAWAYS

Vascular access is a high-frequency, high-stakes skill set for every anaesthesiologist. Peripheral IV cannulation (AS9.1) requires precise knowledge of upper limb venous anatomy, correct gauge selection for the clinical purpose, aseptic non-touch technique, and post-insertion confirmation of patency. Central venous catheterisation (AS9.2) demands anatomical mastery of the IJV, subclavian, and femoral sites; the complete Seldinger sequence (needle → wire → dilator → catheter); maximal sterile barrier precautions; and mandatory post-placement confirmation by waveform transduction and chest X-ray. Ultrasound guidance substantially reduces mechanical complications and is the current standard of care. Simulation-based training using deliberate practice and structured debrief — culminating in formal DOPS assessment — is the required pathway to safe independent practice under the NMC 2024 curriculum. Core safety rules: always control the guidewire, always confirm tip position before use, and always suspect arterial placement when blood appears bright and pulsatile.

REFLECT

Think back to a simulation session where the guidewire did not advance smoothly — or imagine yourself in that situation. What anatomical reason might explain resistance? What would your next steps be? How does deliberately practising failure scenarios in simulation (wire resistance, arterial puncture, pneumothorax) change your readiness compared to reading about these complications alone? Discuss with a peer or faculty how psychological preparation — staying calm and systematic when a procedure is not going to plan — is itself a clinical competency that simulation is uniquely positioned to develop.