scholarly journals LO088: Development of a simulation-based curriculum for ultrasound-guided internal jugular central venous catheterization

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S60-S60
Author(s):  
M. Woodcroft ◽  
M. Holden ◽  
T. Chaplin ◽  
L. Rang ◽  
M. Jaeger ◽  
...  
Keyword(s):  
Performance Metrics ◽  
Deliberate Practice ◽  
Venous Catheter ◽  
High Volume ◽  
Careful Consideration ◽  
Learning Curves ◽  
Central Venous ◽  
Real Patient ◽  
Hand Motion ◽  
Simulation Based

Introduction / Innovation Concept: Insertion of an internal jugular (IJ) central venous catheter (CVC) under ultrasound guidance (USG) is a complex skill that requires considerable practice in order to achieve technical proficiency. Simulation allows novices to engage in structured and high volume repetitive practice of USG IJ CVC insertion and to work through a predictable pattern of errors prior to real patient encounters. Based on earlier work on learning curves for CVC insertion, this curriculum uses a model of simulation-based high volume deliberate practice of the fundamental skills of USG CVC insertion, and was designed with careful consideration of the conditions associated with optimal learning and improvement of performance. Methods: Eight residents (post graduate year 2) from the Departments of Emergency Medicine and Anesthesiology engaged in deliberate practice of USG CVC insertion during three two-hour sessions, at 2-week intervals. Progress of the residents was monitored with direct observation and regular hand motion analysis (HMA), which was compared to performance metrics set by a local expert. Curriculum, Tool, or Material: Students reviewed online introductory ultrasound video and articles outlining internal jugular (IJ) and femoral CVC insertion prior to the first session. Session 1 focused on ultrasound skills including knobology, transducer movement, and needle tracking. This was followed by 60 minutes of deliberate practice of the skills of USG CVC insertion on both femoral and IJ models. During sessions 2/3, students practiced complete gowning and draping using sterile technique. This was followed again by deliberate practice of the skills of USG CVC insertion on both femoral and IJ models. Students received coaching and feedback throughout all sessions, with HMA assessment of USG IJ CVC insertion at the beginning and end of each session. After three training sessions, consisting of 85 total attempts, 5/8 residents surpassed the expert benchmark for probe hand motion, 6/8 for needle hand motion, and 1/8 for total procedure time, with the remaining residents approaching the expert benchmark for each metric. Conclusion: We have successfully developed a simulation-based curriculum for USG IJ CVC placement. Residents demonstrated continuous improvement in each session, approaching or exceeding the expert benchmarks by the end of the third session.

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

CJEM ◽  
2016 ◽  
Vol 18 (6) ◽  
pp. 405-413 ◽  
Author(s):  
Robert McGraw ◽  
Tim Chaplin ◽  
Conor McKaigney ◽  
Louise Rang ◽  
Melanie Jaeger ◽  
...  
Keyword(s):  
Rating Scale ◽  
Deliberate Practice ◽  
Venous Catheter ◽  
Global Rating Scale ◽  
Global Rating ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Simulation Based ◽  
Technical Proficiency ◽  
The Mean

AbstractObjectiveTo 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.MethodsTen 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.ResultsNone 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.ConclusionWe 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.

Pre- and post-review of a standardized ultrasound-guided central venous catheterization curriculum evaluating procedural skills acquisition and clinician confidence

2019 ◽  
Vol 21 (4) ◽  
pp. 440-448 ◽  
Author(s):  
Timothy R Spencer ◽  
Amy J Bardin-Spencer
Keyword(s):  
Central Venous Catheter ◽  
Central Venous Catheterization ◽  
Venous Catheter ◽  
Catheter Insertion ◽  
Central Venous Catheter Insertion ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Clinical Simulation ◽  
Venous Catheterization ◽  
Simulation Based

Background: To evaluate novice and expert clinicians’ procedural confidence utilizing a blended learning mixed fidelity simulation model when applying a standardized ultrasound-guided central venous catheterization curriculum. Methods: Simulation-based education and ultrasound-guided central venous catheter insertion aims to provide facility-wide efficiencies and improves patient safety through interdisciplinary collaboration. The objective of this quality improvement research was to evaluate both novice (<50) and expert (>50) clinicians’ confidence across 100 ultrasound-guided central venous catheter insertion courses were performed at a mixture of teaching and non-teaching hospitals across 26 states within the United States between April 2015 and April 2016. A total of 1238 attendees completed a pre- and post-survey after attending a mixed method clinical simulation course. Attendees completed a 4-h online didactic education module followed by 4 h of hands-on clinical simulation stations (compliance/sterile technique, needling techniques, vascular ultrasound assessment, and experiential complication management). Results: The use of a standardized evidence-based ultrasound-guided central venous catheter curriculum improved confidence and application to required clinical tasks and knowledge across all interdisciplinary specialties, regardless of level of experience. Both physician and non-physician groups resulted in statistically significant results in both procedural compliance ( p < 0.001) and ultrasound skills ( p < 0.001). Conclusion: The use of a standardized clinical simulation curriculum enhanced all aspects of ultrasound-guided central venous catheter insertion skills, knowledge, and improved confidence for all clinician types. Self-reported complications were reported at significantly higher rates than previously published evidence, demonstrating the need for ongoing procedural competencies. While there are growing benefits for the role of simulation-based programs, further evaluation is needed to explore its effectiveness in changing the quality of clinical outcomes within the healthcare setting.

The Long-term Impact of Simulation-Based Training for Central Venous Catheter Insertion

CHEST Journal ◽  
2014 ◽  
Vol 146 (4) ◽  
pp. 492A
Author(s):  
Laura Thomas ◽  
Jonathan Mahnken ◽  
Sally Rigler ◽  
Matthew Sharpe ◽  
Emily Diederich
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Catheter Insertion ◽  
Central Venous Catheter Insertion ◽  
Central Venous ◽  
Simulation Based ◽  
Long Term Impact

scholarly journals Economic Impact of Simulation-Based Training (SBT) for Central Venous Catheter (CVC) Insertion

2015 ◽  
Vol 18 (3) ◽  
pp. A237-A238
Author(s):  
C.V. Asche ◽  
L. Barker ◽  
J. Ren ◽  
M. Kim ◽  
C.S. Kirkness ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Economic Impact ◽  
Venous Catheter ◽  
Central Venous ◽  
Simulation Based
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