This is the podcast, ICU rounds.

My name is Dr. Jeffrey Guy.

I'm an associate professor of surgery and director at the Burns Center at the Vanderbilt University School of Medicine in Nashville, Tennessee.

Welcome back to the podcast.

This is July.

Today's date, to be precise, is July the 16th. And for the past several weeks, we have been enjoying the graduation and promotion of fourth-year medical students to surgical interns and a variety of interns around the country and around the world of basically come into our intensive care units.

And one of the things that make me most apprehensive about this time of year is the actual teaching of invasive procedures to our new interns.

It's one thing to be making rounds in intensive care units and teaching people about ventilators and sepsis, acid-based statuses, but the actual teaching

of manual procedures is extraordinarily difficult, in my opinion.

And I say this as an educator in surgery.

I often find it easier to teach a resident how to do a bowel anasthmosis or something like an appendectomy or a surgical

procedure, then actually teaching him how to do a central line. Because a lot of times when teaching

somebody to do a central line, I really can't see the tip of the catheter, certainly in years

past prior to the use of ultrasound, and its relationship to arterial structures are the apex of the

lung. So for that reason, we're going to talk about today, the thing that causes me the greatest

amount of apprehension in the intensive care unit, particularly in regards to education, and that's

complications associated with central venous catheterization.

I remember as a critical care fellow at the University of North Carolina at Chapel Hill,

going to surgical M&M and listening to residents present complications from a central venous catheter,

and the most common one that they would present was typically a pneumothorax.

And Dr. George Sheldon was the chairman of

surgery then, and he would predictably have a series of questions that regarded the risk factors

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