Development and Internal Validation of a Preliminary Prediction Model for First-Pass Failure During Ultrasound-Guided Internal Jugular Vein Catheterisation in Critically Ill Adults (ROTATE-ICU)

Background: First-pass failure during ultrasound-guided internal jugular vein (IJV) catheterisation is common in critically ill adults and is associated with mechanical complications, yet no model has been developed to estimate its probability before the procedure. We therefore set out to develop and internally validate a preliminary prediction model, ROTATE-ICU. Methods: We conducted a prospective, single-centre, observational cohort study and included 120 of 156 assessed procedures, taking one episode per patient. The pre-specified model combined IJV anterior–posterior diameter, the position of the vein relative to the common carotid artery, and operator experience. The model was fitted with first-pass failure as the outcome and internally validated by bootstrap optimism correction with 1000 replications. Results: First-pass failure occurred in 46 of 120 procedures (38.3%). The odds of failure fell with each millimeter of anterior–posterior diameter (adjusted OR 0.83, 95% CI 0.72–0.95) and with each category of operator experience (adjusted OR 0.29, 95% CI 0.14–0.59), whereas the positional category showed no independent association. The optimism-corrected C-statistic was 0.743, with a calibration slope of 0.914 (95% CI 0.572–1.451) and a Brier score of 0.188. Conclusions: The ROTATE-ICU model estimates the probability of first-pass failure from three variables available at the bedside, of which vein diameter and operator experience carried most of the predictive weight. Because operator experience is itself one of the inputs, the model describes the risk of a given procedure performed by a given operator rather than a fixed property of the patient. The shrinkage-adjusted model and an open-access calculator are available; this is a preliminary model and external validation is now needed.