YouTube as a source of education on tunneled catheter insertion: content and quality analysis (2024)

Background

Tunneled catheters can be inserted for many reasons, and in most centers, and in most centers it is not clear who should insert these catheters. Some anesthesiologists may not have seen first-hand the insertion of a tunneled catheter during their residency, depending on the policies of the institution. YouTube is one of the most commonly used online platforms for accessing medical information. The aim of this study was to investigate the reliability of YouTube videos, for tunneled central venous catheter (Hickman and tunneled hemodialysis catheters) insertion for education.

Methods

The keywords “Tunneled catheter insertion” and “Tunneled central venous catheter insertion” were searched for on YouTube. The first 100 videos ranked by the YouTube algorithm were analysed. Animation and theoretical content videos, as well as videos that included only a part of the catheter insertion, were excluded. The sources of the videos were categorized as medical doctors or professional organizations. medical device advertisement and hospital. Two authors evaluated all videos via the Journal of the American Medical Association (JAMA) benchmark criteria, modified DISCERN scores and the Global Quality Scale (GQS).

Results

Twenty-three videos were analysed in the study. The video quality scores were similar across the video sources. The number of views and the number of likes were significantly positively correlated. Furthermore, a significant correlation was found between the JAMA, Modified DISCERN, and GQS scores. Notably, none of the analysed videos achieved full points in all three scoring systems.

Conclusions

Relying on a single criterion, such as the video source or number of likes, is not sufficient to determine a video's quality. Therefore, what is learned from videos needs to be double-checked. These platforms should be used as an additional tool, not as the primary source of education.

The widespread use of social media has changed our education methods. One of the best known social media platforms is YouTube. Videos on YouTube are used both to inform patients and to provide visual material for practical training [1]. A search of PubMed using the keyword “YouTube” in December 2023 revealed that there have been more than 3000 articles about videos on this platform since 2007. These articles demonstrate that social media platforms have recently become integral to medical education. The COVID-19 pandemic has likely increased this trend [2].

There are several disadvantages of using YouTube for medical education. These include the lack of peer review and the absence of any guidelines, which affect the credibility of the videos. Therefore, it can be difficult for users to assess the quality of the video. As the use of online video platforms in medical education has increased, different methods have become available to evaluate and improve the quality of these videos. The Journal of the American Medical Association (JAMA) benchmark criteria, Modified DISCERN score, and Global Quality Scale (GQS) score are the most common scoring systems in this regard [3,4,5,6].

Tunneled catheters can be inserted by interventional radiologists, surgeons, or anaesthesiologists, depending on institutional preferences. Although anaesthesiologists are familiar with the Seldinger technique and practice inserting various types of central venous catheters, including hemodialysis catheters, there is a possibility of not having education related to this procedure first-hand during residency training.

This study investigated the reliability of videos on YouTube about tunneled central venous catheter insertion.

The keywords “Tunneled catheter insertion” and “Tunneled central venous catheter insertion” were searched on YouTube (https://www.youtube.com, Language: English) in December 2023. We aim to investigate tunneled catheters (Hickman and tunneled hemodialysis catheters), not the implantable ports. The search was performed via default filters. The first 100 videos ranked by the YouTube algorithm were analysed. Irrelevant, animated and theoretical content videos were excluded. Videos that included only a part of the catheter insertion were also excluded (Fig.1).

The following video characteristics were recorded: the channel name, video duration, number of views and likes, and upload date. Channels were divided into medical doctors, professional organizations, medical device advertisements, and hospitals according to the information in the “about” section.

The JAMA benchmark criteria (Table1), Modified DISCERN (Table2) and GQS (Table3) were used to assess the quality of the videos. The JAMA score awards 1 point for each of the following elements: authorship, attribution, currency, and disclosures. The modified DISCERN score consists of five questions that can be answered as yes (1 point) or no (0 points). The GQS is a 5-point Likert-type scale that ranges from 1 (poor quality) to 5 (excellent flow and quality) [3]. Two authors independently and simultaneously reviewed the videos via these scoring systems. For the intergroup analysis, an arithmetic mean of the scores obtained by the authors was used. Correlations for their separate scores were also evaluated.

There were no human or animal participants in this study. Ethical committee approval or clinical trial registration was not required for this study because no patient data were utilized, and all videos were available for public use on the social media website: www.youtube.com.

Statistical analysis

Statistical analysis was performed via SPSS software version 24 for Mac (IBM Corp., Armonk, NY) and Jamovi 2.3 software (The jamovi project (2022), Sydney, Australia, Jamovi Version 2.3, Computer Software, retrieved from https://www.jamovi.org). Shapiro–Wilk tests were used to examine the mean distributions of the quantitative data. Quantitative variables with a normal distribution were compared via the independent samples t test. Two groups of quantitative data that were not normally distributed were compared via the Mann–Whitney U test. The Kruskal‒Wallis test was used to compare more than two groups with nonnormally distributed quantitative variables. The relationships between quantitative variables were analysed via Spearman correlation analysis. The Spearman correlation coefficients were as follows: low (rho: < 0.40), moderate (rho: 0.40–0.59), and high (rho: > 0.60). A fit analysis between the anesthesiologists was investigated by intraclass correlation analysis. Statistical significance was accepted at p < 0.05.

A total of 23 videos were evaluated. A flowchart of the video selection process is provided in Fig.1. The average duration of the videos was about 9min, including videos lasting less than 2min and those lasting slightly more than half an hour. There were videos with as few as 16 views and those with more than 150,000 views. 65% of videos used USG guidance for venous puncture. In 5% of the videos, catheter tip control was performed via intracavitary ECG, whereas fluoroscopy guidance was used in 60% of the videos. In 35% of the videos, the catheter tip position was not checked. General information about the videos, such as source, likes, time since upload, and scores, is given in Table4.

The videos were analysed according to their source, such as medical doctors, professional organizations, medical device advertisements, and hospitals, and it was observed that most of these videos (39.1%) were uploaded from hospital accounts. With respect to the video characteristics, there were no differences in duration, views, or time since the upload day among these groups. There was a significant difference in likes between the groups (p = 0.021). A pairwise comparison revealed that there was a significant difference between medical device advertisements and hospitals (p = 0.032). The JAMA, DISCERN, and GQS scores were also comparable (Table5).

A correlation analysis was performed between the video characteristics in Table6. A moderate correlation was found between JAMA and DISCERN (rho = 0.565, p = 0.005) and between JAMA and GQS (rho = 0.470, p = 0.024). A strong correlation was found between DISCERN and GQS (rho = 0.619, p = 0.002). Additionally, correlations were observed between view and like (rho = 0.717, p < 0.001), view and time since video upload (rho = 0.486, p = 0.019), and like and time since video upload (rho = 0.540, p = 0.008).

Finally, an intraclass correlation analysis between the operators revealed a high fit for the JAMA and GQS scores (ICC = 0.917, p < 0.001; ICC = 0.966, p < 0.001, respectively). This was not performed for the DISCERN scores, as they were exactly the same for the operators.

When searching for keywords on YouTube, the majority of videos focused on central venous catheterization. Among the first 100 videos, only 23 videos focused on central venous catheterization with tunneling. It was difficult to find videos on specific topics, such as tunneled catheter insertion. Two anesthesiologists evaluated 23 videos that had been viewed more than half a million times.

In evaluating YouTube videos, quality assessment tools such as the JAMA score, DISCERN score and GQS are highly regarded. Both anesthesiologists who evaluated the videos had more than three years of experience in tunneled catheter placement. King et al. reported that although there was no difference in video quality ranking between experts and residents, there was a difference in scoring [7]. The educational usability of the videos was scored, and the video quality was found to be average. Video sources compared these scoring systems and video features.

There was no correlation between video source and quality score. Previous studies have shown that video quality varies depending on the source. Videos posted by professional organizations, doctors or hospital accounts often receive higher quality scores [8,9,10,11,12,13,14]. The reason for not finding a similar result in the present study may be the small number of videos and the specificity of the subject.

There was a correlation between JAMA, DISCERN and GQS scores. This is consistent with observations reported in prior studies [15, 16]. There were no videos that received a full score across the 3 scoring systems. In a study that created a 10-step scoring system for CVC insertion on the basis of evidence-based guidelines, none of the videos applied all 10 steps [17].

As with any invasive procedure, complications can develop with central catheters. These may include vascular injuries, pneumothorax, cardiac arrhythmias, infection, and thrombosis. Most of these complications result from a blind approach to venous anatomy. Ultrasound (USG)-guided puncture significantly reduces these risks [18]. However, USG guidance was used in only 65% of the videos in this study. The position of the catheter tip is crucial for preventing catheter malfunction and infection [19, 20]. In 5% of the videos, catheter tip control was performed via intracavitary ECG, whereas fluoroscopy guidance was used in 60% of the videos. In 35% of the videos, the catheter tip position was not checked. Since an intervention-specific scoring system was not created for our study, these major deficiencies could not be directly assessed through the scoring.

In this study, the popularity of videos was not related to higher quality scores, which was in agreement with previous studies [3, 15, 21]. The number of views or likes should not be used as an indicator of quality [22]. Although some studies have shown a correlation between video duration and video quality, this study did not find a similar correlation [5, 23]. There was a correlation between views, likes, and time since video upload, as demonstrated in numerous studies in the literature [16].

Physicians are likely to check out YouTube videos in daily practice before minimally invasive interventions. In a review of 14 different studies, 85% reported that the quality of the videos was poor [24]. Therefore, it could be difficult to find useful and high-quality videos. This study revealed that the quality of videos cannot be predicted on the basis of a single criteria.

The lack of theoretical knowledge of the subject being watched could be dangerous. There may be incorrect or incomplete information in the videos. Reading the textbook on the subject to be learned and knowing the current instructions will prevent the wrong videos from being watched. The reliability of videos that do not take adequate precautions for patient safety should be questioned. In the case of tunneled catheters, this may include not following asepsis rules and not using USG and fluoroscopy guidance.

Platforms created exclusively for healthcare video education or medical society websites can also be utilized (www.vumedi.com,www.cirse.org, www.openanesthesia.org). These platforms typically operate on a membership basis, feature peer-reviewed content, and may require a fee. In future studies, videos on these platforms can be analysed.

This study has several limitations. Videos were searched according to YouTube's default settings. The results are affected by many factors, such as interactions, and may differ from those of every user. After a keyword search, many videos focused on something other than tunneled catheter placement. Therefore, the number of videos was limited.

The authors would like to thank Dr. Yüsra Şirin for her support.

Code availability

Not applicable.

Authors and Affiliations

1. Department of Anesthesiology and Intensive Care, Marmara University Pendik Training and Research Hospital, Fevzi Çakmak Mah. Muhsin Yazıcıoğlu Cad. No:10, Pendik, Istanbul, 34890, Turkey

   Merve Ergenç&Ruslan Abdullayev

2. Department of Anesthesiology and Intensive Care, Marmara University School of Medicine, Marmara University School of Medicine, Başıbüyük Campus Başıbüyük Mah. Maltepe Başıbüyük Yolu Sok. No: 9/2, Istanbul, 34854, Turkey

   Ruslan Abdullayev

Contributions

Conceptualization: Merve Ergenç, Ruslan Abdullayev; Methodology: Merve Ergenç, Ruslan Abdullayev; Formal analysis and investigation: Merve Ergenç, Ruslan Abdullayev; Writing - original draft preparation: Merve Ergenç, Ruslan Abdullayev; Writing - review and editing: Merve Ergenç, Ruslan Abdullayev; Funding acquisition: Merve Ergenç, Ruslan Abdullayev; Resources: Merve Ergenç, Ruslan Abdullayev; Supervision: Merve Ergenç, Ruslan Abdullayev. All listed authors meet the ICMJE criteria. We confirm that the manuscript has been read and approved by all named authors.All listed authors meet these conditions: a. Substantial contributions to the conception and design, acquisition, or analysis and interpretation of data; and, b. Drafting the article or revising it critically for important intellectual content; and, c. Final approval of the version to be published; and, d. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Merve Ergenç.

Ethics approval and consent to participate

There were no human or animal participants in this study. Ethical committee approval or clinical trial registration was not required for this study because no patient data were utilized, and all videos were available for public use on the social media website www.youtube.com.

Competing interests

The authors declare no competing interests.

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