Where do ICU trainees really look? An eye-tracking analysis of gaze patterns during central venous catheter insertion

Abstract

Background: There is limited knowledge about gaze patterns of intensive care unit (ICU) trainee doctors during the insertion of a central venous catheter (CVC). The primary objective of this study was to examine visual patterns exhibited by ICU trainee doctors during CVC insertion. Additionally, the study investigated whether differences in gaze patterns could be identified between more and less experienced trainee doctors. Methods: In a real-life, prospective observational study conducted at the interdisciplinary ICU at the University Hospital Zurich, Switzerland, ICU trainee doctors underwent eye-tracking during CVC insertion in a real ICU patient. Using mixed-effects model analyses, the primary outcomes were dwell time, first fixation duration, revisits, fixation count, and average fixation time on different areas of interest (AOI). Secondary outcomes were above eye-tracking outcome measures stratified according to experience level of participants. Results: Eighteen participants were included, of whom 10 were inexperienced and eight more experienced. Dwell time was highest for CVC preparation table ( p = 0.02), jugular vein on ultrasound image ( p < 0.001) and cervical puncture location ( p < 0.001). Concerning experience, dwell time and revisits on jugular vein on ultrasound image ( p = 0.02 and p = 0.04, respectively) and cervical puncture location ( p = 0.004 and p = 0.01, respectively) were decreased in more experienced ICU trainees. Conclusions: Various AOIs have distinct significance for ICU trainee doctors during CVC insertion. Experienced participants exhibited different gaze behavior, requiring less attention for preparation and handling tasks, emphasizing the importance of hand-eye coordination.