Early on in his career, Dr. Jack LeDonne, MD, FACS, VA-BC™, was confident in his ability to do blind sticks based on anatomical landmarks. In his mind at the time, using ultrasound to place lines was unnecessary, if you knew what you were doing.
What transpired to bring his practice and interest in vascular access from blind sticks to stardom?
Through an unparalleled drive to find the undiscovered and share it with others, Dr. LeDonne became a pioneer in the specialty of vascular access.
Finding vascular access
In the era of “see one, do one, write the paper,” as Dr. LeDonne recalled, resident physicians were shown once how to insert lines. After that, it was up to them to teach themselves.
And until Dr. LeDonne encountered a patient with some troublesome anatomy, he was confident in his line insertions. When he chatted with a group of interventional radiologists on a break one day, he brushed off their talk of using ultrasound to help guide insertions.
“We didn’t need ultrasound. We just stuck it in anatomical landmarks,” he said.
Soon after this conversation, he encountered a patient whose jugular vein he could not access. He recalled that it looked like she had normal anatomy, but he struggled to establish access.
Then, he remembered his conversation with the interventional radiologists and called for an ultrasound machine.
The machine helped him find that the jugular vein was separated from carotid artery.
“I wasn’t taught that the carotid and the jugular could be that separated,” he remembered. “I saw that there might be some advantage to this, knowing the structures, that if they were in an ‘abnormal’ position, that [ultrasound] could determine that.”
His interest was piqued.
Studying the film
He began to practice with ultrasound machines when they were not in use. He also frequently used a needle guide. After enough insertions and plenty of time spent observing interventional radiologists place lines, he abandoned the needle guide, though he still suggests that everyone learns with them.
He began to record his procedures to document his findings, like the separated carotid and jugular. He also found new topics to fuel his research.
In one topic of study, he found that he could cannulate the cephalic vein in the deltopectoral groove in larger patients.
“It hit me that I had never heard of this,” Dr. LeDonne said. “I realized that if I was finding something ‘new,’ this would be new for everybody in surgery and probably everybody else, except for radiologists that were doing this routinely.”
“I saw that there might be some advantage to this.”
He submitted his findings to the Journal of the American College of Surgeons, along with his videos to show how he conducted the procedure.
To his surprise, the journal wanted to publish both his paper and his videos. They were the first videos the journal published.
“I realized video was my medium. I could show people these findings and it would broaden their experience.”
He began attending local and national conferences in vascular access, and he used his videos when presenting. The first time he presented with his videos in tow, the formerly unreactive crowd came alive with questions.
Dr. LeDonne was ready with answers.
Knowledgeable clinicians = Quality care
He has continued to teach others through his career in vascular access. Moreover, he has never stopped learning about this specialty.
In December 2010, Dr. LeDonne sat to take the first VA-BC™ exam. Thirteen years later, he still holds his credential.
“I thought that a credential like that would be the right thing to have. How many physicians in the country have that?” he said.
“There’s no education or certificate that ever hurt you… If you’re looking to get certified, make it happen.”
As the landscape of vascular access and healthcare in general changes, he urges other clinicians to strive for education, whether that be through certifications, getting involved in local or national conferences, or joining research projects. More knowledgeable clinicians, Dr. LeDonne said, leads to elevated careers, advanced practice opportunities, and more quality results for patients.
“I see RNs moving in and taking over the procedure, and certainly advanced education will be the first criteria they have in hospitals if they want nurses to move into these advanced vascular access procedures,” he said. “I think everybody, particularly patients, would be better off.
“There’s no education or certificate that ever hurt you… If you’re looking to get certified, make it happen.”
