Simulation training improves insertion of central venous catheters

Research Activities, February 2011, No. 366

Critically ill patients in the emergency department and intensive care unit may have central venous catheters (CVCs) inserted into a neck, chest, or groin vein. These catheters are used to deliver medications and fluids, as well as monitor central venous pressure to regulate fluid balance. Resident physicians normally learn how to do the procedure by observing someone else. However, there are now simulation training programs that allow residents to practice a procedure over and over again before actually performing it on a live patient.

A new study finds that such simulation training improves CVC insertion performance, including first-time insertion. It also appears to be more effective than traditional training. For this study, 90 first- and second-year residents received a slide presentation and then watched 3 videos demonstrating the insertion technique. This was followed by hands-on simulation training using a simulator designed for this purpose. Another group of 95 residents were trained in CVC insertion by observing at the bedside. Senior physicians served as independent raters and did not know what type of training each resident received. A total of 115 residents performed 494 CVC insertions, which were observed by the raters. The first measure was how successful a resident was at accessing the vein and inserting a needle under ultrasound guidance. The success rate for this was 51 percent in the simulation group and 37 percent in the bedside group. The second measure of success was the actual insertion of the CVC. Success rates were 78 percent for the simulation group and 67 percent for the bedside group.

According to the researchers, simulation training was independently and significantly associated with first needle and CVC insertion. This was true regardless of the resident's specialty or the patient's medical problems. The study was supported in part by the Agency for Healthcare Research and Quality (HS16725).

See "Simulation training in central venous catheter insertion: Improved performance in clinical practice," by Leigh V. Evans, M.D., Kelly L. Dodge, M.D., Tanya D. Shah, M.D., and others in the September 2010 Academic Medicine 85(9), pp. 1462-1469.

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