Simulation-based Training in Ultrasound Assisted Central Venous Catheterization.

Abstract

BACKGROUND: More than 5 million central venous catheters (CVCs) are inserted in the USA each year, and although these catheters can be life saving, they are also associated with significant risks; 75% of complications arising from procedures like CVC occur in the first 30 cases of a physician’s career. A structured CVC training program9 and the use of ultrasound guidance for CVC placement, 7, 10, 11 increased patient safety by reducing complication rates. 8, 10–14 Simulation-based procedural trainers have demonstrated validity in transferring skills to applied clinical environments,1–6 and the use of simulators for CVC training is valuable because skills can be honed before attempting to perform the procedure on a live patient, thereby increasing patient safety. METHODS: Fifty-four Internal Medicine Interns received training and were assessed through didactic and one-on-one instruction in Ultrasound-guided CVC procedures using Blue Phantom? vascular access simulation models. After individual instruction, subjects independently practiced placement procedures using Ultrasound machines and standard catheter kits using one or more of 4 types of models: leg, arm, and head/neck anatomical models and a simple block model. Six-point Likert scales were used to assess pre- and post-test procedural self-efficacy, CVC performance on head/neck models, perceived value of simulation-based training, and an open response for subjects to write down what they learned. RESULTS: Mean subject score on the knowledge-based quiz was 91.68 / 100.00 (SD = 11.99). Subjects performed in the good to very good range for CVC performance (M=4.74, SD = .44). The small standard of deviation suggests that the training results were uniformly consistent. There were no significant differences between the type of practice model and CVC performance. There were no significant differences in CVC performance based on the number of previously placed CVCs, although prior placement ranged from zero to 35 (M = 4.33, SD = 4.97). This suggests that the instruction was effective independent of the experience level of the learner. Subjects indicated that after simulation-based training they were more confident in helping with CVC (t = -9.25, p =.000) and in performing CVC on their own (t = -13.52, p =.000). Subjects ranked the overall quality of instruction as very good (M = 5.25, SD = 0.17). More than half (57.4%) of the subjects made specific comments about what they learned during the training session, including specific mechanical techniques (83.87%), how to operate the equipment (67.74%), infection control techniques (38.71%), safety measures and contraindications (35.49%), associated complications (22.58%), specific anatomy (25.8%), and the advantages of practice (19.35%). CONCLUSION: The simulation-based training model that we employed using Ultrasound guidance and Blue Phantom? models for procedural training demonstrates that the integration of these components provides trainees with the tools they need to successfully demonstrate understanding and techniques associated with placing a CVC, and that the students perceived the training as effective. The logical next step is to assess the trainings effectiveness on the transfer of knowledge and skills to the clinical setting.