Challenges and experience factors related to anatomical variations in invasive procedures in the emergency department of a university hospital

Abstract

Anatomical variations may complicate invasive procedures in the emergency department (ED) and reduce procedural success. This study aimed to evaluate the impact of anatomical variations on the success of invasive procedures and to examine the effects of medical staff experience, professional role, and imaging device use. This prospective observational study was conducted between January and September 2025 in the ED of a university hospital. A total of 96 adult patients with identified anatomical variations during invasive procedures were included. Demographic data, procedure type, medical staff characteristics, imaging device use, and procedural outcomes were recorded. Of the patients, 34.4% were female, and the median age was significantly higher in males than in females (p=0.019). A significant positive correlation was observed between years of professional experience and procedural success (r=0.561, p<0.001). Procedural success was significantly higher when anatomical variations were known before the intervention (61.9% vs. 36.0%, p=0.033). Success rates differed significantly according to professional role (p<0.001), with the highest rates observed among paramedics and emergency medical technicians. Although procedures performed with imaging device support showed higher success rates, this difference was not statistically significant (p=0.317). No significant association was found between procedure type and success rate (p=0.659). In ED invasive procedures, medical staff experience and prior awareness of anatomical variations are key determinants of procedural success. These findings are consistent with existing literature emphasizing the importance of experience and anatomical assessment in improving first-attempt success and patient safety in emergency care settings.