Standardization and Simulation Training for Central Venous Catheter Placement to Improve Patient Safety

Background:

Improved methods for training medical residents on common procedures offer the possibility of minimizing complications. Currently residents are often trained to perform procedures such as central venous catheter (CVC) placement on real patients in neither a rigorous nor a standardized manner. There is also frequently no clear measure for competency of CVC placement.

Purpose:

Our goals were to implement a standardized training and certification program for CVC placement and to test this program on a cohort of medicine residents.

Description:

The standardized training and certification program for CVC placement included development of: (1) a procedure note template, (2) a procedure checklist, (3) certification tools, and (4) simulation training to familiarize trainees with the entire procedure. Effectiveness was evaluated by assessing trainee CVC placement knowledge (10‐question test) and comfort survey before and after completion of curriculum and simulation training. The central line procedure template note we created included use of patient safety recommendations such as: (a) ultrasound‐guided internal jugular (IJ) placement, (b) needle guide to optimize angle of entry, (c) wide sterile barrier techniques and hand washing, (d) documentation of complications, and (e) completion of time‐out universal protocol. We developed a standardized best‐practice checklist to evaluate resident ability to competently perform insertion of CVC on simulator using ultrasound and needle guide as observed by an instructor. This standardized checklist was given to all incoming Stanford residents. We created a Web site with CVC curriculum and self‐assessment testing that we required all incoming medicine interns to complete. Incoming medicine interns (n = 36) completed simulation training during orientation week. Small groups (n = 3) were paired with an instructor and evaluated using the standardized competency checklist to complete insertion of CVC on chicken model. Comfort levels for CVC placement improved from 1.4 to 3.5/5 after training. Knowledge base testing improved from 6.5 to 9/10 after completing the CVC Web site curriculum.

Conclusions:

Results to date are promising. We propose a certification process requiring passing a knowledge test and completing simulation training before proceeding to patients. The central line note template and standardized checklist will be disseminated throughout our hospital via CVC kits. We hope to see a decrease in CVC complications such as iatrogenic pneumothorax with this approach.

Author Disclosure:

L. Shieh, none; L. Meinke, none; K. Bowes, none; J. Lee, none; F. Mihm, none; B. Gavi, none; K. Posley, none; Z. Edmonds, none; N. Szaflarski, none; K. Tabb, none.