Developing a Tool to Assess Placement of Central Venous Catheters in Pediatrics Patients

Fleming, Geoffrey M.; Mink, Richard; Hornik, Christoph P.; Emke, Amanda R.; Green, Michael L.; Mason, Katherine; Petrillo, Toni; Schuette, Jennifer; Tcharmtchi, M. Hossein; Winkler, Margaret; Turner, David A.

doi:10.4300/jgme-d-15-00365.1

Cited by 10 publications

(3 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…28 Despite the availability of numerous objective measures of CVC placement skill, including a checklist specifically designed for PCCM, most fellowship programs still rely on a "gestalt" assessment of fellow competence in the procedure. 4,29 In our study, we combined the standard practice for assessment within our fellowship program, attending observation and evaluation, with objective measurement of motion fluidity and manual dexterity using HMA. By both measures, fellows gained skill in CVC placement through apprenticeship training in clinical context, a finding which provides "relationship to other variables" validity evidence for the LOS scale used for attending evaluation.…”

Section: Discussionmentioning

confidence: 99%

Central Venous Catheter Placement Skill Acquisition Through Apprenticeship Training in Clinical Context during Pediatric Critical Care Medicine Fellowship: A Longitudinal Study

Good,

Miller,

Kendall

et al. 2023

J Pediatr Intensive Care

View full text Add to dashboard Cite

Pediatric critical care medicine (PCCM) fellows must develop competence in central venous catheter (CVC) placement. The impact of experiential learning opportunities in the clinical context on PCCM fellow CVC placement skill acquisition remains unknown. We sought to measure femoral CVC placement skill acquisition during fellowship and compare fellow to attending skill. We performed a prospective observational cohort study of PCCM fellows at the University of Colorado from 2019 to 2021. Femoral CVC placement skill was measured by attending evaluation of level of the supervision (LOS) required for the fellow, and hand motion analysis (HMA) on simulation task trainer. Competence in femoral CVC placement was defined as LOS ≥ 4 (can perform this skill independently) on a 5-point Likert scale. We compared fellow skill in femoral CVC placement to years of training and number of femoral CVCs placed. We also compared third-year fellow and attending HMA measurements. We recruited 13 fellows and 6 attendings. Fellows placed a median of 8 (interquartile range 7, 11) femoral CVCs during the study period. All fellows who reached third-year of fellowship during the study period achieved competence. Longitudinal analysis demonstrated improvement in CVC placement skill by both LOS and HMA as years of fellowship and number of femoral CVCs placed increased. Few third-year fellows achieved attending level skill in femoral CVC placement as measured by HMA. PCCM fellows acquired skill in CVC placement during fellowship and achieved competence in the procedure, but most did not reach attending level of skill.

show abstract

Section: Discussionmentioning

confidence: 99%

Central Venous Catheter Placement Skill Acquisition Through Apprenticeship Training in Clinical Context during Pediatric Critical Care Medicine Fellowship: A Longitudinal Study

Good,

Miller,

Kendall

et al. 2023

J Pediatr Intensive Care

View full text Add to dashboard Cite

show abstract

“…16 Compared to other USG procedures such as CVC placement, there is a paucity of assessment tools for USG PIV placement. 6,17,18 A TSC for USG PIV placement has been described, but objective measures of competence are lacking. 14 HMA provides an objective and potentially less labor-intensive alternative to traditional assessment tools.…”

Section: Discussionmentioning

confidence: 99%

Hand motion analysis for assessment of nursing competence in ultrasound-guided peripheral intravenous catheter placement

et al. 2018

View full text Add to dashboard Cite

Introduction: Objective measures such as hand motion analysis are needed to assess competency in technical skills, including ultrasound-guided procedures. Ultrasound-guided peripheral intravenous catheter placement has many potential benefits and is a viable skill for nurses to learn. The objective of this study was to demonstrate the feasibility and validity of hand motion analysis for assessment of nursing competence in ultrasound-guided peripheral intravenous placement. Methods: We conducted a prospective cohort study at a tertiary children's hospital. Participants included a convenience sample of nurses with no ultrasound-guided peripheral intravenous experience and experts in ultrasoundguided peripheral intravenous placement. Nurses completed hand motion analysis before and after participating in a simulation-based ultrasound-guided peripheral intravenous placement training program. Experts also completed hand motion analysis to provide benchmark measurements. After training, nurses performed ultrasound-guided peripheral intravenous placement in clinical practice and self-reported details of attempts. Results: A total of 21 nurses and 6 experts participated. Prior to the hands-on training session, experts performed significantly better in all hand motion analysis metrics and procedure time. After completion of the hands-on training session, the nurses showed significant improvement in all hand motion analysis metrics and procedure time. Few nurses achieved hand motion analysis metrics within the expert benchmark after completing the hands-on training session with the exception of angiocatheter motion smoothness. In total, 12 nurses self-reported 38 ultrasound-guided peripheral intravenous placement attempts in clinical practice with a success rate of 60.5%. Discussion: We demonstrated the feasibility and construct validity of hand motion analysis as an objective assessment of nurse competence in ultrasound-guided peripheral intravenous placement. Nurses demonstrated rapid skill acquisition but did not achieve expert-level proficiency.

show abstract

“…With regards to PCCM Fellowship trainees, Nishisaki et al described an innovative “bootcamp” which showed that simulation can be used in Fellowship trainees to improve vascular access skills ( 28 ). Fleming et al used compliance with a checklist as an assessment tool to evaluate PCCM Fellows in a simulated CVL placement which has given promise to help evaluate trainees ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

Declining Procedures by Pediatric Critical Care Medicine Fellowship Trainees

et al. 2018

View full text Add to dashboard Cite

Background: Pediatric Critical Care Medicine Fellowship trainees need to acquire skills to perform procedures. Over the last several years there have been advances that allowed for less invasive forms of interventions.Objective: Our hypothesis was that over the past decade the rate of procedures performed by Pediatric Critical Care Medicine Fellowship trainees decreased.Methods: Retrospective review at a single institution, tertiary, academic, children's hospital of patients admitted from July 1, 2007–June 30, 2017 to the Pediatric Intensive Care Unit and Cardiothoracic Intensive Care Unit. A Poisson regression model with a scale adjustment for over-dispersion estimated by the square root of Pearson's Chi-Square/DOF was applied.Results: There has been a statistically significant decrease in the average rate of central venous lines (p = 0.004; −5.72; 95% CI: −9.45, −1.82) and arterial lines (p = 0.02; −7.8; 95% CI: −13.90, −1.25) per Fellow per years in Fellowship over the last 10 years. There was no difference in the rate of intubations per Fellow per years in Fellowship (p = 0.27; 1.86; 95% CI:−1.38, 5.24).Conclusions: There has been a statistically significant decrease in the rate of central venous lines and arterial lines performed by Pediatric Critical Care Medicine Fellowship trainees per number of years in Fellowship over the last 10 years. Educators need to be constantly reassessing the clinical landscape in an effort to make sure that trainees are receiving adequate educational experiences as this has the potential for an impact on the education of trainees and the safety of the patients that they care for.

show abstract

Developing a Tool to Assess Placement of Central Venous Catheters in Pediatrics Patients

Abstract: Background Pediatric critical care medicine requires the acquisition of procedural skills, but to date no criteria exist for assessing trainee competence in central venous catheter (CVC) insertion.

Cited by 10 publications

References 32 publications

Central Venous Catheter Placement Skill Acquisition Through Apprenticeship Training in Clinical Context during Pediatric Critical Care Medicine Fellowship: A Longitudinal Study

Central Venous Catheter Placement Skill Acquisition Through Apprenticeship Training in Clinical Context during Pediatric Critical Care Medicine Fellowship: A Longitudinal Study

Hand motion analysis for assessment of nursing competence in ultrasound-guided peripheral intravenous catheter placement

Declining Procedures by Pediatric Critical Care Medicine Fellowship Trainees

Contact Info

Product

Resources

About