Evaluating the Impact of Assessment Metrics for Simulated Central Venous Catheterization Training

Abstract

Introduction: Performance assessment and feedback are critical factors in successful medical simulation-based training. The Dynamic Haptic Robotic Trainer (DHRT) allows residents to practice ultrasound-guided needle insertions during simulated central venous catheterization (CVC) procedures while providing detailed feedback and assessment. A study was performed to examine the effectiveness of the DHRT in training the important skills of needle tip tracking and aspiration and how these skills impact procedural complications in simulated CVC. Methods: The DHRT data were collected for 163 residents at 2 hospitals for 6 simulated needle insertions. Users were given automated feedback on 5 performance metrics, which measure aspiration rate, arterial punctures, punctures through and through the vein, loss of access to the vein, and successful access to the vein. Aspiration rates and tip tracking rates were analyzed to determine their significance in preventing CVC complications and improving performance. Results: Tip tracking rates higher than 40% were 2.3 times more likely to result in successful venous access than rates less than 10%. Similarly, aspiration rates higher than 80% were 2.6 times more likely to result in successful venous access than rates less than 10%. Proper tip tracking and aspiration both reduced mechanical complications. Resident performance improved for all metrics except tip tracking. Conclusions: Proper tip tracking and aspiration both reduced complications and increased the likelihood of success. However, the skill of tip tracking was not effectively learned through practice without feedback. Therefore, ultrasound-guided needle-based procedures, including CVC, can be improved by providing specific feedback to users on their ultrasound usage to track needle insertions.

Evaluating the effects of comprehensive simulation on central venous catheterization training: a comparative observational study

“…The DHRT is made up of a haptic robotic arm, simulated ultrasound screen, and mock ultrasound probe [ 14 ], and includes 17 patient cases that differ based on the IJV size, depth, and location [ 15 , 16 ]. In addition, the DHRT has a personalized learning interface [ 17 ] that provides automated performance feedback on various metrics including needle angle, number of insertion attempts, rate of aspiration, and needle centering [ 18 ] without the need for a trained observer. The DHRT was validated finding that is was as effective as manikin simulators based on a US-IJCVC checklist [ 19 ].…”