Simulation Training in Central Venous Catheter Insertion: Improved Performance in Clinical Practice

Evans, Leigh V; Dodge, Kelly L; Shah, Tanya; Kaplan, Lewis J.; Siegel, Mark D.; Moore, Christopher L.; Hamann, Cara; Lin, Zhenqiu; D’Onofrio, Gail

doi:10.1097/acm.0b013e3181eac9a3

Cited by 170 publications

(134 citation statements)

References 44 publications

(35 reference statements)

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“…[5][6][7][8] Simulation allows novices to engage in repetitive practice without any risk to patients, and supports development of carefully structured curricula designed around established principles of learning and improvement of performance. 9 With respect to skills such as USG CVC insertion there is, however, a paucity of evidence for the specific type and volume of simulator practice required to achieve technical proficiency.…”

Section: Introductionmentioning

confidence: 99%

Development and Evaluation of a Simulation-based Curriculum for Ultrasound-guided Central Venous Catheterization

McGraw

Chaplin

McKaigney

et al. 2016

CJEM

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Objective: To develop a simulation-based curriculum for residents to learn ultrasound-guided (USG) central venous catheter (CVC) insertion, and to study the volume and type of practice that leads to technical proficiency. Methods: Ten post-graduate year two residents from the Departments of Emergency Medicine and Anesthesiology completed four training sessions of two hours each, at two week intervals, where they engaged in a structured program of deliberate practice of the fundamental skills of USG CVC insertion on a simulator. Progress during training was monitored using regular hand motion analysis (HMA) and performance benchmarks were determined by HMA of local experts. Blinded assessment of video recordings was done at the end of training to assess technical competence using a global rating scale. Results: None of the residents met any of the expert benchmarks at baseline. Over the course of training, the HMA metrics of the residents revealed steady and significant improvement in technical proficiency. By the end of the fourth session six of 10 residents had faster procedure times than the mean expert benchmark, and nine of 10 residents had more efficient left and right hand motions than the mean expert benchmarks. Nine residents achieved mean GRS scores rating them competent to perform independently. Conclusion: We successfully developed a simulation-based curriculum for residents learning the skills of USG CVC insertion. Our results suggest that engaging residents in three to four distributed sessions of deliberate practice of the fundamental skills of USG CVC insertion leads to steady and marked improvement in technical proficiency with individuals approaching or exceeding expert level benchmarks. RÉSUMÉObjectifs: L'étude visait à élaborer un programme de formation axé sur la simulation et conçu à l'intention des résidents en vue de l'apprentissage de la mise en place échoguidée de cathéters veineux centraux (CVC), et à déterminer le nombre et le type d'exercices pratiques permettant d'en arriver à la compétence technique. Méthode: Dix résidents, en deuxième année d'études de cycles supérieurs, en médecine d'urgence et en anesthésie ont participé à quatre séances de formation de deux heures chacune, tenues à deux semaines d'intervalle, dans le cadre d'un programme structuré de pratique intentionnelle sur simulateur, en vue de l'acquisition des compétences de base dans la mise en place échoguidée de CVC. Les progrès réalisés durant la formation ont été suivis de près à l'aide d'un outil régulier de mesure, l'Hand Motion Analysis (HMA), et les valeurs de référence ont été déterminées par l'HMA des experts locaux. À la fin des séances de formation, les compétences techniques enregistrées sur bande vidéo ont fait l'objet d'une évaluation à l'insu par des experts, sur une échelle globale de notation (EGN). Résultats: Au départ, aucun des résidents n'atteignait l'une ou l'autre des valeurs de référence. Au fil de la formation, les mesures de l'HMA des résidents ont révélé une amélioration constante et i...

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Section: Introductionmentioning

confidence: 99%

Development and Evaluation of a Simulation-based Curriculum for Ultrasound-guided Central Venous Catheterization

McGraw

Chaplin

McKaigney

et al. 2016

CJEM

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“…1,8,9 We point out in particular the fact that pneumothorax, a complication with greater morbidity, is rare, occurring in less than 1% of the jugular approaches and up to 1.5% of the subclavian approaches. 1,8,14 Puncture site, number of punctures and male gender are factors associated with a greater chance of complications. 8,15,16 In our study, we observed that the jugular puncture site had a higher rate of mechanical and infectious complications compared to the subclavian vein.…”

Section: Discussionmentioning

confidence: 99%

Complications of central venous catheter insertion in a teaching hospital

Comerlato

Rebelatto

Almeida

et al. 2017

Rev. Assoc. Med. Bras.

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Introduction: Central venous catheters are fundamental to daily clinical practice. This procedure is mainly performed by residents, often without supervision or structured training. Objective: To describe the characteristics of central venous catheterization and the complication rate related to it. Method: Retrospective cohort study. Adult patients undergoing central venous catheter insertion out of the intensive care unit (ICU) of a teaching hospital were selected from March 2014 to February 2015. Data were collected from medical charts using an electronic form. Clinical and laboratory characteristics from patients, procedure characteristics, and mechanical and infectious complications rates were assessed. Patients with and without complications were compared. Results: Three hundred and eleven (311) central venous catheterizations were evaluated. The main reasons to perform the procedure were lack of peripheral access, chemotherapy and sepsis. There were 20 mechanical complications (6% of procedures). Arterial puncture was the most common. Procedures performed in the second semester were associated with lower risk of complications (odds ratio 0.35 [95CI 0.12-0.98; p=0.037]). Thirty-five (35) catheter-related infection cases (11.1%) were reported. They were related to younger patients and procedures performed by residents with more than one year of training. Procedures performed after the first trimester had a lower chance of infection. Conclusion: These results show that the rate of mechanical complications of central venous puncture in our hospital is similar to the literature, but more attention should be given to infection prevention measures.

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“…Dr Moore strongly advocates for ultrasound first and always when you are putting needles in the central circulation. [60][61][62][63][64][65][66][67][68][69] …”

Section: Christopher L Moore Md Rdms Rdcsmentioning

confidence: 99%

2012 Ultrasound First Forum Proceedings

Minton

Abuhamad

2013

Journal of Ultrasound in Medicine

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Simulation Training in Central Venous Catheter Insertion: Improved Performance in Clinical Practice

Abstract: Simulation training was associated with improved in-hospital performance of CVC insertion. Procedural simulation was associated with improved residents' skills and was more effective than traditional training.

Cited by 170 publications

References 44 publications

Development and Evaluation of a Simulation-based Curriculum for Ultrasound-guided Central Venous Catheterization

Development and Evaluation of a Simulation-based Curriculum for Ultrasound-guided Central Venous Catheterization

Complications of central venous catheter insertion in a teaching hospital

2012 Ultrasound First Forum Proceedings

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