Simulation‐Based Education Reduces Complications from Central Venous Catheter Insertion

Background:

Invasive medical procedures are the second most common cause of preventable adverse events in hospitalized patients. Central venous catheter (CVC) insertion is associated with life‐threatening complications such as arterial puncture, pneumothorax, and catheter‐related bloodstream infection. Simulation‐based education has been used to provide safe acquisition of clinical skills in CVC insertion and may result in reduced complications. The aim of this study was to compare the rate of complications related to CVC insertion before and after an educational intervention.

Methods:

Beginning in December 2006, all second‐ and third‐year internal medicine residents rotating through the medical intensive care unit (MICU) at a university‐affiliated tertiary‐care hospital were required to complete an 8‐hour simulation‐based education program in subclavian (SC) and internal jugular (IJ) CVC insertion. Results from 8 months of actual SC and IJ CVCs inserted by simulator‐trained residents in the MICU were compared with 4 months of SC and IJ CVCs inserted by traditionally trained residents (non‐simulator‐trained). The primary inserter of each CVC was surveyed daily regarding several quality indicators: (a) number of skin punctures, (b) arterial puncture, (c) need for CVC adjustment after chest X‐ray, (d) successful CVC insertion, and (e) pneumothorax. To assess the effect of simulation‐based education on catheter‐related bloodstream infections (CRBSIs), rates were measured in the MICU (16 months preintervention and 12 months postintervention) and a comparison nonmedical ICU (28 months) in accordance with protocols described by the National Healthcare Safety Network,

Results:

Simulator‐trained residents reported significantly fewer skin punctures (1.32 vs. 1.74; P < 0.0005), arterial punctures (1% vs. 14%; P < 0.0005), and need for CVC adjustment (4% vs. 21%; P = 0.002) and higher CVC insertion success rates (95% vs. 81%; P = 0.005) than traditionally trained residents. The groups did not differ in pneumothorax rate (2% vs. 2%). There were fewer CRBSIs after the simulator‐trained residents entered the MICU (0.51 infections per 1000 catheter‐days) compared with both the same unit prior to the intervention (3.20 per 1000 catheter‐days, P = 0.003) and with the other nonmedical ICU (4.94 per 1000 catheter‐days, P = 0.003) during the entire study period.

Conclusions:

A simulation‐based education intervention in CVC insertion significantly reduced procedural complications and improved patient outcomes. Improved quality of care included a reduction in the immediate complication of arterial puncture and the delayed complication of CRBSI. Simulation‐based education is a valuable adjunct to traditional methods of procedural education.

Author Disclosure:

J Barsuk, none; E. Cohen, none; J. Feinglass, none; W. McGaghie, none; D. Wayne, none.