Current practice, training and skill assessment of central venous access device insertion: Perspectives of intensive care trainees in adult intensive care units across Australia and New Zealand and their recommendations for improvement:

Objective: Central venous access device (CVAD) insertion is a routine procedure in intensive care units (ICUs); however, it is associated with procedural risks. While structured training enhances safety, significant variability exists in training, supervision, and competency assessment across ICUs. Standardised education and assessment frameworks are recommended to improve procedural safety and patient outcomes. This study aimed to evaluate ICU trainees' experiences with CVAD insertion training, identify any significant variation in current educational frameworks, and gather recommendations for enhancing training and assessment. Design: A web-based survey was distributed to ICU trainees across Australia, New Zealand, Singapore, and Hong Kong. Data were analysed using descriptive statistics and regression models. Main outcome measures: Key outcomes included trainee's perceptions of training disparities, accreditation processes, and practice variations across ICUs, informing the development of a standardised CVAD training framework. Results: Among 237 respondents, 199 responses were analysed. Fewer than two-thirds of trainees in tertiary and metropolitan ICUs and only 17% in regional and private ICUs, reported access to structured multimodal CVAD training, while 15.3% indicated no formal training was available. Fewer than a quarter (23.1%) of less experienced trainees reported having undergone competency assessments in the past 12 months. Commonly perceived challenges included coordinating ultrasound guidance and manipulating the guidewire and catheter. Most trainees (52.3%) recommended six to ten supervised insertions and competency across multiple insertion sites (∼60%) for accreditation. Conclusions: These findings highlight trainees' perceptions of critical gaps in CVAD training, emphasising the need for structured multimodal education, standardised competency assessments, and improved access to training resources across diverse ICU settings.